THE KINDERGARTEN LAUNCH LAB Registration Form

THE KINDERGARTEN LAUNCH LAB Registration Form

Student Enrollment & Learning Profile Form - Presented by The Kindergarten Readiness Initiative - Thank you for your interest in The Kindergarten Launch Lab. This form helps us learn more about your child so that we can create an individualized learning experience designed to strengthen foundational skills and support school readiness. * IMPORTANT INFORMATION * Our first two sessions are dedicated to assessment and planning. During these initial sessions, we will: 1.) Observe your child’s learning behaviors and engagement 2.) Conduct informal and formal assessments as appropriate 3.) Identify strengths and areas for growth 4.) Establish individualized learning goals 5.) Create a personalized action plan Following the completion of the assessment process, families will receive a written summary of findings and a recommended learning plan outlining the goals and focus areas for future tutoring sessions.
Parent & Child Information
Parent/Guardian Name
Relationship to Child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Method of Communication
Child’s Full Name
Date of Birth

MonthDayYear
Date
Current Age
Current Grade/Classroom
Services, Skills, and Learning Profile
Has your child ever received any of the following support services?

Other
Feel free to share more details:
Child's Current Academic Level

Please give an accurate response to each question/indicator below. This will help us understand more about your child's individual needs.
Recognizes some letters
Recognizes letter sounds
Recognizes own name
Can retell a story
Answers questions about stories
Holds writing tools appropriately
Writes first name
Draws shapes
Counts objects accurately
Recognizes numbers
Identifies patterns
Please let us know if you have other children that you are enrolling (give names, ages, and date or birth for each additional child). Share important background information about each child as well.
Sorts objects by attributes
Goals, Concerns, and Interests
Priority Learning Goal 1
Priority Learning Goal 2
Priority Learning Goal 3
Biggest concerns regarding your child’s readiness for the upcoming school year
Learning Interests

Other
Other Learning Interest
Package Selection and Scheduling
Preferred Package
Preferred Day(s)
Preferred Time
Parent/Guardian Signature
Date (Parent Agreement)

MonthDayYear
Date
My Products
prevnext( X )
Weekly Pay Option for 1 hour per weekend per child
1 hour every weekend (choice of Saturday or Sunday) *This amount will be owed each week within the 8 week time period UNLESS you are opting to only pay for the weeks you attend*

$80.00 Quantity



Weekly Pay Option for 2 hours per weekend per child
1 hour each day -or- 2 hours in one day (choice of Saturday, Sunday, or both days) *This amount will be owed each week within the 8 week time period UNLESS you are opting to only pay for the weeks you attend*

$125.00 Quantity



8 Weekends Paid in Full (discount option) per child
1 hour for 8 consecutive weekends (choice of Saturday or Sunday) *$40.00 discount*

$600.00 Quantity



8 Weekends Paid in Full (discount option) per child
1 hour each day -or- 2 hours in one day for 8 consecutive weekends (choice of Saturday, Sunday, or both days) *$50.00 discount*

$950.00 Quantity



Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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THE KINDERGARTEN LAUNCH LAB Registration Form

Parent & Child Information

Services, Skills, and Learning Profile

Child's Current Academic Level

Goals, Concerns, and Interests

Package Selection and Scheduling

My Products

Payment Methods