Pierce After-School Suncrest Tutoring Permission Form
Student’s Name _______________________________ Parent’s Name ________________________
Teacher Tutoring ______________________________ Date of Tutoring ______________________
Concept needing extra help ___________________________________________________________
I give my permission for my child to stay after-school for tutoring on Tuesday’s and Wednesday’s from 3:005:30pm. I understand transportation will not be provided and that my child will need to be picked up by 5:30
PM. Starting on Tuesday-3 November 2015 through 27 January 2016. No Tutoring on 18 Nov, 25 Nov, and the
week of 15 December 2015.
Parent Signature ___________________________________________________________________
Phone Number _____________________________Emergency Number________________________________
All tutoring permission slips are due the week before tutoring. If your child cannot be picked up by 5:30, or if
permission slip is not returned, they are not permitted to stay.
C O N T A C T
I N F O R M A T I O N
F O R M
Child’s Name:__________________________________________
Parents Name(s): ___________________________________________________________________________
Home Phone: __________________ Cell Phone: __________________ Other Phone: __________________
PRINCIPAL PURPOSE(S) for which emergency contact information is intended to be used: (1) Person(s) to be notified in
case of emergency (2) Provides several means of contacting parents for emergency or pick up from tutoring.
Person(s) to be notified in case of an emergency or pickup:
Name(s):
___________________________________ Relationship: Relative □ Friend □ Other _______________
Home Phone: _______________ Cell Phone: _______________ Other Phone: _______________
Secondary person to be notified in case of emergency:
Name(s):
___________________________________ Relationship: Relative □ Friend □ Other _______________
Home Phone: _______________ Cell Phone: _______________ Other Phone: _______________
Additional friends/family who have permission to pick up my child from camp. Please include babysitters or other
child care providers that may pick up/drop off your child(ren).
Name:
_______________________________________ Phone: ____________________________________
Name:
_______________________________________ Phone: ____________________________________
Name:
_______________________________________ Phone: ____________________________________
Parent’s Signature _________________________________________________ Date: ____________________
Pierce After-School Suncrest Tutoring
October 22, 2015
Dear Parents:
Your child has been selected to participate in free afterschool tutoring through
the Suncrest Church program. Tutoring will begin November 3, 2015 and end
January 27, 2016 (no tutoring Nov. 18th, Nov. 25th and the week of December
15th). Tutoring will be offered during the following times:
3:00-5:30 PM
Tuesday and Wednesday (2.5 hours per day)
Students need to be picked up promptly at 5:30pm.
The goal of the program is to increase learning opportunities for your child.
Students will work in small groups to build basic skills. Extra practice in either
English Language Arts or Math will lead to improved test scores. Please note
that participation in tutoring takes precedence over sports, after school clubs
or other extracurricular activities.
This is a homework helping session. It is important for you to help your child with
classroom homework. Good behavior and regular attendance are required.
Poor behavior will cause your child to be dismissed from the program. Two
unexcused absences will lead to removal from tutoring. Students who are not
picked up before 6:00pm will be removed from the program.
Please complete the form attached to acknowledge you have received this
letter and to provide transportation information. Tutoring forms are due no later
than November 1st and spots will be filled on a first come, first served basis. If
you have any questions, please contact us at 650-5308.
Sincerely,
Mrs. Christine Wheeler, Principal
Mr. Nicholas Petralia, Assistant Principal
Clifford Pierce Middle School