Amanda Scaramozzino

Laurier Students for Literacy Co-

ordinator
Office Phone: 519-756-8228, Ext.
5913
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 Wednesday, November 18th, 2009 and
the deadline is Friday, December 18th, 2009. Registration forms are
available at the Brantford Public Library.

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

Comments:
 Amanda Scaramozzino
Laurier Students for Literacy Co-
ordinator
Office Phone: 519-756-8228, Ext.
5913
lsflbrantford@wlusu.com

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 Friday, December
18th, 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. 5913 or e-mail us at lsflbrantford@wlusu.com.
 Amanda Scaramozzino
Laurier Students for Literacy Co-
ordinator
Office Phone: 519-756-8228, Ext.
5913
lsflbrantford@wlusu.com

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)

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.
 Amanda Scaramozzino
Laurier Students for Literacy Co-
ordinator
Office Phone: 519-756-8228, Ext.
5913
lsflbrantford@wlusu.com

Parents Name (please print) Signature

Date
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.
Amanda Scaramozzino
Laurier Students for Literacy Co-
ordinator
Office Phone: 519-756-8228, Ext.
5913
lsflbrantford@wlusu.com