Orton-Gillingham

Small Groups

CAST Reading Specialists will run small groups for 1 hour after school each week. The day and time may vary depending on instructor availabilty and school district. Space is limited. Once your registration form is received you will be contacted with program details. Students will work on phonemic awareness, blending drills, reviewing reading skills and learning new reading and spelling skills. SMALL GROUPS ARE FREE for the 2023/2024 school year thanks to our partnership with Marian University Center for Vibrant Schools

Student Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

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Birthdate

What school does your child attend?

Current Grade (must be in 1st or 2nd grade)

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

Parent/Guardian Name(s)

Parent/Guardian Phone

(###)

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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 reading specialist’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 Signature:

Orton-Gillingham

Small Groups

CAST, INC