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DOBI Reading Program Registration
Please complete the Registration Form below.
What type of services are you looking for? (Can check multiple)
*
Required
Reading, Writing, and/or Comprehension
Math Tutoring
Executive Functioning Coaching
I'm Not Sure
Which one of our locations are you registering for?
Choose an option
Student's Full Name
Student's Age
Student's Grade Level
Parent/Guardian Full Name
Email
Phone
How many lessons per week are you looking for?
*
1
2
3
4
5
6+
Not sure
Is the student homeschooled or part of any reated program?
*
Yes
No
Is English the student's first language? If not, what is their primary language?
Does the student speak other languages at home? If so, please list languages spoken and/or written.
Is the student in French Immersion?
*
Yes
No
Has a psychoeducational assessment been completed?
*
Yes
No
Does the student have any sensitivities?
What areas does the student struggle with most?
Are there any medical issues to be aware of? If so, please list and outline any special instructions.
How did you hear about the DOBI program?
SUBMIT
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