Multi-Sensory Math

Tutoring Registration:

Multi-Sensory Math Tutoring is provided by trained tutors and will take place either at your child’s school or at our office at the Community Learning Center and typically last for 1 hour to 45 minutes. This tutoring is free for the upcoming 2023/2024 academic year due to our partnership with Marian University’s Center for Vibrant Schools!

Fill out the registration form below and include your preferred tutoring times and dates. We will do our best to accommodate your preferences but we do have very limited availability for math tutoring.

You will be contacted with additional details after your registration form is received!

Student Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Birthdate

Current Grade

School District

Please list any academic, social or health needs we should be aware of:

Please list preferred tutoring days and times. We recommend 2 sessions per week for best results.

Parent/Guardian Name(s)

Parent/Guardian Contact Information (please provide phone numbers for each parent)

Parent/Guardian Email

I authorize the following people to transport my child to/from CAST Tutoring. In the event of an emergency if CAST cannot reach me CAST is authorized to contact and release information to the following people:

Provide names and contact info for each emergency contact

CAST needs to able to release and exchange student information with your child's school district in order to collaborate regarding specific learning needs.

Specific information to be exchanged: any and all information pertaining to the student’s needs that will aid in assisting the math instructor’s work with your student.

I allow CAST to release and exchange information with my student's school district.

I do NOT allow CAST to release and exchange information with my student's school district.

In order to receive the funding which now makes tutoring FREE, we need to add our tutoring data in with the larger pool at Marian University. This will include our students in their data showing progress and student success! Please read the agreement below and check the box allowing us to share student data with Marian University Center for Vibrant Schools.

Data from the CAST Orton-Gillingham Tutoring Program will be gathered, analyzed and disseminated in accordance with the Data Sharing Agreement between CAST and CVS, Marian University. Marian University will use student information collected by CAST, such as birth date, name, assessment data and progress data. Data from the CAST Orton-Gillingham Tutoring Program will be gathered, analyzed and disseminated. Student records will be destroyed upon completion of the CAST and Marian agreement period.

I allow my student's data to be shared with Marian University Center for Vibrant Schools.

I do NOT allow my student's data to be shared.

This registration form is complete and accurate, and participant has permission to engage in all activities unless otherwise specified in writing. I understand that C.A.S.T. assumes no responsibility for injuries or illnesses which my child may sustain as a result of his/her participation in programming, the use of any equipment, facilities, exercises, or other activities. I expressly acknowledge that I assume the risk for any and all injuries and all illnesses which may result from his/her participation in these activities. I acknowledge that my child had been medically cleared to participate in vigorous physical activity. I also understand that there is a risk of injury while participating in physical activity by my child. I agree to hold harmless C.A.S.T. , its staff and volunteers for accidents or injuries arising out of his/her participation in the activity. In the event of a medical emergency, I understand that appropriate measures will be made to contact parents, guardians, and emergency contacts listed, however, give permission for C.A.S.T. to contact EMS on behalf of my child for treatment should the need arise. I understand that I assume the obligations that may arise from this event, should it occur. I also give permission to the personnel of C.A.S.T. and or local media to take photographs of my children to be used in marketing materials for C.A.S.T. I verify that I have the legal authority to speak on behalf go this minor, and assume responsibilities as stated above. I hereby consent for my child to participate in C.A.S.T. Tutoring programming:

Parent/Guardian Electronic Signature:

Multi-Sensory Math

Tutoring Registration:

CAST, INC