Auburn University 2012 Summer Reading Program
Mondays
and Wednesdays, June 6-July
18, 2012
or Tuesdays and Thursdays, June 5-July 17, 2012
Child's name:
________________________________________________________________________
Age: ________ Date of
birth: ______________________________________ Sex: Male Female
Parents or caretakers:
__________________________________________________________________
Address: _________________________________________ E-mail:
_____________________________
City: ___________________________ State: _____________________ Zip: ___________________
Telephone
Home:
__________________ Work:
__________________
Cell: __________________
Emergency contact:
____________________________________________________________________
Telephone: _____________________________ Relation:
_____________________________________
School and teacher 2011-2012:
___________________________________________________________
Grade 2011-2012: _____ Promoted? Yes
No Enrolling in AU Summer
Enrichment Program? Yes No
Any special conditions (medical conditions, handicaps,
allergies)? Yes No If yes, describe: _______
_____________________________________________________________________________________
Has child been Summer Reading before? If so, when?
_________________________________________
Does child have trouble seeing? Yes No Does child wear
glasses/contact lenses?
Yes No
Does child have trouble hearing? Yes No Does child use a hearing aid? Yes No
Does child enjoy reading?
_______________________________________________________________
Problems with reading you have noticed:
___________________________________________________
_____________________________________________________________________________________
Topics child might like to read about:
______________________________________________________
Most
tutoring will take place in 45-minute sessions between 8:00 and 8:45 twice a
week. The tutor will contact you
about the specific lesson time. Preferred days for tutoring:
____
Mondays & Wednesdays ____
Tuesdays & Thursdays if available
(Grades
K-2 only)
(Grades
3-6 struggling readers)
We will
arrange parking in the Stadium Parking Deck for the duration of the program.
Parents will deliver children in the Summer Reading Program by foot or shuttle
bus to the west entrance to Haley Center on Duncan Drive and meet them there 45
minutes later. Tutoring will take place in 2423 HC.
Driver(s) who will deliver and pick up my child for tutoring: ______________________________
Car make and license:
_________________________________________________________________
Person to contact if child has no ride: __________________________
Phone: __________________
Please complete both pages of
this form.
Please mark class days on the calendar your child could attend tutoring at the Summer
Reading Program. (Priority will be given to children who can attend the entire
12-session program.)
|
Sunday |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
|
3 |
4 |
5 |
6 First Meeting
(pretests) |
7 |
8 |
9 |
|
10 |
11 Tutoring |
12 |
13 Tutoring |
14 |
15 |
16 |
|
17 |
18 Tutoring |
19 |
20 Tutoring |
21 |
22 |
23 |
|
24 |
25 Tutoring |
26 |
27 Tutoring |
28 |
29 |
30 |
July 2012
|
Sunday |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
|
1 |
2 Tutoring |
3 |
4 HolidayÑno
tutoring |
5 |
6 |
7 |
|
8 |
9 Tutoring |
10 |
11 Tutoring |
12 |
13 |
14 |
|
15 |
16 Tutoring |
17 |
18 Last Meeting
(posttests) |
19 |
20 |
21 |
|
Sunday |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
|
3 |
4 |
5 First Meeting
(pretests) |
6 |
7 Tutoring |
8 |
9 |
|
10 |
11 |
12 Tutoring |
13 |
14 Tutoring |
15 |
16 |
|
17 |
18 |
19 Tutoring |
20 |
21 No tutoring
(exams) |
22 |
23 |
|
24 |
25 |
26 Tutoring |
27 |
28 Tutoring |
29 |
30 |
July 2012
|
Sunday |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
|
1 |
2 |
3 Tutoring |
4 |
5 Tutoring |
6 |
7 |
|
8 |
9 |
10 Tutoring |
11 |
12 Tutoring |
13 |
14 |
|
15 |
16 |
17 Last
Meeting (posttests) |
18 |
19 |
20 |
21 |
I,
the undersigned parent/legal guardian of _________________________________ acknowledge that accidental injury can
result from participation in the Auburn University Summer Reading Program
activities. I, therefore, assume
all risk, loss, or damage of property arising out of the participation in this
program. I release Auburn University,
its Board of Trustees, faculty, and staff from all liabilities from any right
of action that may accrue either to my child or myself, heirs or
representatives, for any such injuries, errors or omissions that I or my child
may suffer while participating in this program.
________________________________________________
_______________________________
Signature of parent/guardian
Date
If
you wish to enroll more than one child, or if you have a friend who is
interested in our program, please copy this form and return one form for each
child you wish to register. You
will be notified about acceptance by early June. If your child is accepted, the
fee for the entire program is $80.00, payable at that time, and includes
parking in the Stadium Parking Deck during the program. Checks should be made payable to Auburn
University. Applications should be
sent to:
Dr. Bruce Murray, Summer
Reading Program
5040 Haley Center, Auburn
University AL 36849
For links and lessons
about learning to read and pictures from the Summer Reading Program, visit the
Reading Genie website: http://www.auburn.edu/rdggenie