Tutorial Centre Participant Registration Form

May/June 2020 Tutorial Program

Colibri will be offering a distance learning tutorial program for ages 12 to 14 from May 25-June 26, 2020.

Session Venue: Sessions will take place online (via Zoom, etc.)

Session Dates: There will be 10 sessions in total over the five-week period (May 25-June 26, 2020). Sessions will be one hour in length and take place twice per week.

Registration Desk: tutorialcentre@colibrilearning.org

Registration Fee: Waived for the first 5 weeks

Orientation Session: May 18th, 2020, 4:00-5:00pm

Please complete the form below to register your child for the May 25-June 26, 2020 Tutorial Program.

Student Information

Student Name

First Name

Last Name

Date of Birth

YYYY

Home Address

Weekly Availability

There will be 10 sessions in total over the five-week period (May 25-June 26, 2020). Sessions will be one hour in length and take place twice per week. Please pick the possible days you would be available for the sessions:

Monday/Wednesday 11:00 a.m.-12:00 p.m.

Monday/Wednesday 4:00-5:00 p.m.

Tuesday/ Thursday 11:00 a.m.-12:00 p.m.

Tuesday/ Thursday 4:00-5:00 p.m.

Wednesday/ Friday 11:00 a.m.-12:00 p.m.

Wednesday/ Friday 4:00-5:00 p.m.

Other Availability

Please fill in

Permission to Attend

The following must be completed by a parent or guardian.

Name of Parent/Guardian

First Name

Last Name

Mobile #

(###)

###

####

Media Release

Do you give permission for your child’s photograph or electronic image to be taken during the Tutorial Centre and used for national or international promotional material and newsletters.

By signing this part of the form, you agree that:

I have granted our child permission to participate in the program specified above.

I acknowledge that the rules and policies for the Tutorial Centre, with which I am familiar, apply at all times, and that any breach of those rules by the Student may result in the Student’s dismissal.

In the case of personal injury, loss or damage, I, or a third party, will not hold Colibri Learning Foundation and its agencies and volunteers responsible.

Date

YYYY

Contact Us

Colibri Learning Foundation

Tutorial Centre Participant Registration Form