Summer Scholars Registration

Parent/Guardian Name*

First Last

Address*

Street Address City State ZIP Code

Cell Phone*

Work/Alternate Phone*

Email*

Community*

Preferred time frame for your child to be contacted for reading / tutoring*

9:00AM - 12:00PM
12:00PM - 3:00PM
3:00PM - 6:00PM
After 6:00PM
No Preference

To engage with tutors, my child has access to (check all that apply)*

Laptop Computer
Desktop Computer
iPad/Tablet
SmartPhone with Internet access
Regular Cell Phone or Landline Phone

How many children would you like to register?*

Please enter a number from 1 to 5.

Name*

First Last

Date of Birth*

Gender*

Male
Female

School*

Grade (2020-2021)*

Name

First Last

Date of Birth

Gender

Male
Female

School

Grade (2020-2021)

Name

First Last

Date of Birth

Gender

Male
Female

School

Grade (2020-2021)

Name

First Last

Date of Birth

Gender

Male
Female

School

Grade (2020-2021)

Name

First Last

Date of Birth

Gender

Male
Female

School

Grade (2020-2021)

To register more than five (5) children, please contact your community's GIDE Coordinator.

Release*

By signing below, I grant permission for my child / children to participate in all aspects of the Summer Scholars Program. I agree that I have received, read, and understand a detailed overview of the Summer Scholars Program and am aware that all tutoring will occur online or over the telephone. All tutors have agreed to the GIDE Online Tutoring Policy. It is important that you similarly instruct your child on the guidelines for communicating and interacting with GIDE tutors. We strongly encourage that the relationship your child has as a participant in the Summer Scholar Program be limited to the online / telephone reading and tutoring services. Should you choose to permit your child to communicate with a tutor he/she met through the GIDE program outside of the program, it is your responsibility to oversee that relationship. GIDE will have no responsibility for interactions outside of the online / telephone reading and tutoring.

I have read the release and give my child/children permission to participate.

Signature*

Phone

This field is for validation purposes and should be left unchanged.