Registration Forms

Child's Name:

First Last

Gender:

Phone #:

Child's Age:

School Name:

Grade in Fall:

Home Address:

Street Address Address Line 2 City State ZIP Code

Date of Birth:

Mother's name:

First Last

Email

Phone

Father's name:

First Last

Email

Phone

Select session choices:*

Individual Summer In-Person Tutoring. (50 minute session) $70
Individual Summer Remote on Zoom Tutoring. (50 minute session) $70

Check your preferred days

Please indicate all time slots your child has available

Preferred times:

Additional dates & times may be available upon request

Reading Level, Goals & Concerns:

Release Form*

I grant permission for my child’s photo to be shared on our online sites.

No Refunds/No Makeups*

I Accept the Summer Reading Club No Refunds/No Makeups Policy

At The Reading Whisperer, we thoughtfully prepare for each session, providing focused, high-quality instruction tailored to your child's success. Tutoring sessions are each fifty minutes, to allow time to provide a recap to parents picking up and receive the next student.

SELECT AND RESERVE YOUR TIMES FIRST
Let me know what dates and times your reader is available this summer. Availability is First Come First Served. Once we agree and confirm summer time slots, they are reserved with your advance payment. Tuition is due by May 1, 2025. Contact me for easy ways to pay!

NO REFUNDS OR MAKEUPS FOR MISSED SESSONS
Each session reserves exclusive time for your child's progress. Due to limited availability and high demand, payments are non-refundable, regardless of attendance, ensuring fairness and availability for all clients. Missed sessions cannot be rescheduled or credited.

This policy ensures consistent, high-quality service for every student. Thank you for valuing this dedicated instruction time. For questions, please reach out.

Signature of Parent*

Please print your name as replacement for electronic signature.

Date*