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Reading and Writing Clinic Registration

Photo from Monmouth University Literacy Center

Cost: $100 per child
You will be required to pay the registration fee in total on the first day of class. Please bring a check for $100.00 made out to Monmouth University. You also can pay with any major credit card.

Student Name(Required)
Please enter the first, middle, and last name of your elementary student in the order requested.
Does your child go by a nickname? If so, please list.
MM slash DD slash YYYY
Please list the full name of the school the student attends.
Please write in the full name of the school district that the student attends.
Please enter the name of legal guardian or parent.
Student's Legal Address(Required)
Please list the complete address with street, town add zip code
If your child is enrolled in the Reading/Writing Clinic, s/he is expected to attend every day that the Clinic is in session. Are there any days that he or she would not be able to attend? If so, please list below.
Student's Grade(Required)
Permission to Contact Child's Teacher(Required)
If my child is enrolled in the Reading and Writing clinic, I give my permission for the Monmouth University Reading and Writing Clinic to contact my child’s teacher and discuss his or her performance and progress in reading and writing. I give permission for the Monmouth University Reading Clinic to request from the teacher any written documents pertaining to my child’s reading and writing performance during the present school year or any previous school years, and to use this information for teaching purposes. All information will be held strictly confidential. At the conclusion of the Reading and Writing Clinic, I understand that a copy of the report of my child’s performance during the Reading and Writing Clinic may be shared with my child’s teacher.
Permission for Child's Temperature Check at Drop Off(Required)
If my child is enrolled in the Reading and Writing clinic, I give my permission for the Monmouth University Reading and Writing Clinic to take my child’s temperature at drop off. If my child’s temperature is above 100.4, I understand my child will not be able to stay for the clinic. I also understand that I must be able to provide my child with a mask. They will be required to wear this mask for the duration of each session.
This field is for validation purposes and should be left unchanged.