Registration Spring 2027
January 4, 2027 - May 28, 2027
Child's name
*
First Name
Middle Name
Last Name
Child's age
*
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's grade
*
School of attendance
*
Teacher's name
*
First Name
Last Name
I'm enrolling my child in:
*
Simple Code B Class: WEDNESDAYS 9:00-12:00, 1/6-5/26, $270/mo
Basic Code A Class: WEDNESDAYS 2:00-5:00, 1/6-5/26, $270/mo
Basic Code B Class: FRIDAYS 9:00-12:00AM, 1/8-5/28, $270/mo
Basic Code B Class: FRIDAYS 2:00-5:00PM, 1/8-5/28, $270/mo
Complex Code 1B Class: THURSDAYS 9:00-12:00, 1/7-5/27, $270/mo
Complex Code 2A Class: TUESDAYS 9:00-12:00, 1/5-5/25, $270/mo
Individualized: 1x per week in 60 min sessions, 1/4-5/28, $360/mo
Individualized: 2x per week in 40 min sessions, 1/4-5/28, $450/mo
Other
Does child have a diagnosis in any of the following categories?
Dyslexia
Learning disability
Hearing
Vision/needs glasses
Speech
Other
Does child have an IEP? If so, please provide a copy.
Yes
No
1st parent or other legal guardian name
*
First Name
Last Name
1st parent or legal guardian phone
*
-
Area Code
Phone Number
1st parent or legal guardian email
*
example@example.com
1st parent or legal guardian address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
2nd parent or other legal guardian name:
First Name
Last Name
2nd parent or legal guardian phone
-
Area Code
Phone Number
2nd parent or legal guardian email
example@example.com
Child resides mainly with:
*
1st parent
2nd parent
Both
Legal guardian
Emergency contact person
*
First Name
Last Name
Emergency contact phone
*
-
Area Code
Phone Number
1st additional person who may pick up your child:
*
First Name
Last Name
2nd additional person who may pick up your child:
First Name
Last Name
Please describe your child's current reading abilities/difficulties:
Please describe your wishes/goals for your child's literacy development:
Are there any physical, behavioral, or mental health conditions that may impact your child during this program? Please describe.
Does your child have any special dietary requirements or allergies?
*
What are some of your child's interests?
Is there anything else you'd like us to know about your child?
What are your child's schedule limitations?
Do we have permission to take photos and videos of your child engaged in literacy activities?
Yes
No
If so, may we use photos and videos of your child for promotional and educational purposes on our website, in print, or on social media? (If we use them, we'll do so WITHOUT an accompanying name.)
*
Yes
No
By signing I represent that I am the parent or legal guardian of the child being enrolled, and have full legal authority to register the child in the RFL program and to determine and designate the emergency contact for the child, as well as those persons authorized to pick up the child.
*
Registration
*
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Registration Spring 2027
$150.00
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