Amanda Scaramozzino

Laurier Students for Literacy Co-ordinator

Office Phone: 519-756-8228, Ext. 5819
lsflbrantford@wlusu.com

LSFL Book Buddy Registration Form

The Book Buddy program is a free program run by Laurier Student’s for
Literacy. We offer one-on-one tutoring for 45 minutes a week. All the volunteers are
eager to support and build confidence in your child’s reading and writing skills through
literacy activities and worksheets. This program is available to students in grades 1 to
6. If you are interested in this program, registration starts on Monday, August 31st,
2009 and the deadline is Monday, September 28th,2009. Registration forms are
available at the Brantford Public Library.

Child’s Information

Parent/Guardian Name: Gender:

Child’s Name: Age:
Phone Number: Grade:
Home Address: Reading Level:
E-mail Address:

Emergency Contact:

We will contact this person only in the event of an emergency, or if the child’s
parent/guardian is not available.

Name of Emergency Contact Person:

Relation to Child:
Phone Number:

How will your child get to and from the library each week?

1. Walk with parent or guardian

2. Drive with parent or guardian
3. Bus with parent or guardian
4. Other (please specify)
 Amanda Scaramozzino
Laurier Students for Literacy Co-ordinator
Office Phone: 519-756-8228, Ext. 5819
lsflbrantford@wlusu.com

Medical Information

Please list any allergies and/or medical information (ex. Diabetes, hearing problems,
vision impairment, peanut allergy, etc.) and medicine or intervention required.

I authorize that the above information about is up to

date and correct.

Parents Name (please print) Signature Date

Areas for Improvement in Written Work (Please put a check mark beside the
ones that pertain to your child):

Sentence Structure Creative Writing Summarizing Materials

Spelling Organizing Ideas Grammar/Punctuation
Story Sequencing Proofreading Vocabulary Development
Phonics Journal Writing Written Response

Comments:

Areas for Improvement in Oral Reading:

Comprehension Retelling the Story Reading with Expression

Pronunciation Fluency Making Connections
Predictions Word Recognition Decoding
Inferences
 Amanda Scaramozzino
Laurier Students for Literacy Co-ordinator
Office Phone: 519-756-8228, Ext. 5819
lsflbrantford@wlusu.com

Comments:

Learning Disabilities: (Please list any learning disabilities below)

Availability:

Please indicate the times that work best for you and your family by numbering your
choices from 1-5, 1 being your top choice.

Time Monday Tuesday Wednesday Thursday

4:00
5:00
6:00
7:00

Thank you! You can expect to be contacted by your child’s buddy

within the next few weeks!

Reminder: The deadline for the Book Buddy Sign-Up is Monday, September 28th,
2009. Please drop off the forms at the Brantford Public Library. If you have any
questions or concerns please feel free to contact Amanda Scaramozzino LSFL Co-
ordinator or Sue Matthews Book Buddy Executive at 519-756-8228, ext. 5819 or e-
mail us at lsflbrantford@wlusu.com.
 Amanda Scaramozzino
Laurier Students for Literacy Co-ordinator
Office Phone: 519-756-8228, Ext. 5819
lsflbrantford@wlusu.com

Laurier Students for Literacy (LSFL)

Book Buddy Program

Photograph Permission Form

Dear Parents/Guardians:

As you know, your child is participating weekly in the Laurier Students for Literacy Book
Buddy program at the Brantford Public Library. We are very excited that you child is
participating with us and we hope you find the program beneficial.

Later this year, we are hoping to take a few photographs of our volunteers “in action” while
they read with the students in the Book Buddy program at the library.

We are requesting your permission to include your son/daughter in a few of these

photographs. These photos will be used only for promotional purposes and materials, as on
posters and brochures. They may also be posted on the Laurier Students for Literacy website
in a photo album. Your child’s name will not appear on any materials, in accordance
with the Laurier Students for Literacy Confidentiality Agreement.

Please complete the following information and return to your child’s Book Buddy.

Thank you,

Amanda Scaramozzino, Laurier Students for Literacy Co-ordinator

____________________________________________

YES, I give permission for to be photographed with his/her

Book Buddy for Laurier Students for Literacy promotional materials. I understand that my
child’s identity (eg. name) will not be shared in any matter.

Name: Signature: Date:

NO, I do not give permission for to be photographed with

his/her Book Buddy for Laurier Students for Literacy promotional materials.