NEW HOPE TUTORIALS

DANVERS MINI TUTORIALS and WORKSHOP New Hope Tutorials Fall 2010

You are welcome to register for any of the MINI TUTORIALS or WORKSHOPS offered at our Danvers location, using this form.

MINI-TUTORIAL APPLICANTS please note the following (this does NOT apply to workshop students!):

* If you have not done so already, please call to set up a Family Interview with Mrs. Joan Smith.

* If you are a NEW FAMILY or NEW STUDENT, please fill out our ONLINE ENROLLMENT form, which is required along with the interview (found at our website).

Please note: If you have more than one child registering for New Hope, you must fill out a separate REGISTRATION PACKET for each child. When you're doing a form for a second child, you do not have to repeat general information. Just indicate "see (child's name) form."

Thank you!

Part I: Student Information and Parent Contact Information

* Parent names (mother and father, first and last)

* Student's name

* Student's D.O.B./age as of Sept 2010

* Student's (approximate) grade level as of Sept. 2010

* Mailing address

* Family Phone Number

* Other day-time phone number for emergency contact (parent's cell phone, neighbor or friend's phone)

Work/day-time phone (parent at work or cell phone)

* Parents' Email Addresses

Part II: Family Demographic Information

If you plan to have more than one student at New Hope, you only need to respond the the questions in this section for the first child. Skip for any subsequent children.

Father's place of business

Mother's place of business

Father's areas of expertise (eg. finance, marketing, computer graphics, carpentry, etc.)

Mother's areas of expertise (see above)

Current place of worship (please include town)

Part III: Registration and Financial Information

Submit payment for Minis and Workshops in full at the time of registration.

12-week Mini-Tutorials (Writing, Art) 18 hours of academic instruction: $250.00 **SAVE $25! Register by November 1st for $225.

6-week Workshops (8-10 year olds) (1.5 hours per week): VALUE-PRICED at $75 each workshop! **SAVE $10! Register by September 1st for $65.

Theater and/or Mime Workshop for ages 11-18 (1.5 hours per week): $90 for 12 weeks **SAVE $10! Register by September 1st for $80.

Please note: workshops and mini tutorials require a minimum number of six students and will not exceed twelve students.

8-10 Year Old WORKSHOP OFFERINGS (6 weeks)

NEW OFFERINGS! Workshops for 8-10 year olds to be held on MONDAYS. You may choose the art workshop or the writing workshop OR BOTH (offered as complementary program).

Students who take both of our fall Fantasy Workshops in one session will create a scrapbook/collage of final work to bring home. Each workshop must have six students in order to run.

Fall session: September 13 through October 25, MONDAYS only

Winter session: January 10 through February 6, MONDAYS only

Spring session: April 25 to June 1st, MONDAYS only

ART: Your child will spend time with instructor creating themed artwork pieces (pencil sketches, painting, paper mache and other media).

WRITING: Your child will be reading and writing poems and short stories based on the art theme.

(See our website for full workshop descriptions.)

Fantasy Art "A" block, 9:00-10:30 am/Mon (Fall session)

Pls sign me up now for January session as well

Pls sign me up now for April session

Fantasy Writing "A" block, 10:45 am -12:15 pm/Mon (Fall session)

Pls sign me up now for January Session as well.

Pls sign me up now for April Session

6TH & 7TH GRADE MINI-TUTORIAL OFFERINGS (usually 11-12 year olds)

NEW OFFERINGS! Mini-Tutorials for 6th/7th grades will be held on WEDNESDAYS. You may choose one or both subject areas. Each tutorial must have six students to run. Students enrolled in the fall session will have priority placement into the winter session.

Calendar Dates:

Mini Tutorials (Writing, Art): Wed. January 19 through Wed. April 13 (12 weeks)

Acting and Mime workshops: Wed. November 3 through Wednesday February 9 (to prepare for Valentine Evening)

MINI Tutorial in ART (winter session only) (10:45 am -12:15pm/Wed.)

MINI Tutorial in WRITING (winter session) (9-10:30am/Wed)

Mime workshop "A" (10:45am-12:15pm/Wed.)

Mime workshop "B" (12:45 - 2:15 pm/Wed.)

Acting workshop (9-10:30am/Wed.)

FUTURE WORKSHOP IDEAS! Let us know if you'd be interested! (Price TBD)

I am interested in the following (*possible*) workshop offerings (ages 10-up). Please send me more information by email.

Woodbuilding Workshop, winter session (February start date)

Lego Robotics Workshop, fall session (October start date)

Part IV: Medical Forms

Please fill out BOTH the Authorization for Medical Treatment section AND the Allergy Alert Form.

* Insurance Carrier (company name)

* Insurance Policy Number

* Local person(s) to contact if parent/guardian cannot be reached. Please indicate order of preference and all contact numbers.

* Physician's name

* Physician's Phone Number

* Dentist's Name

* Dentist's Phone Number

Special instructions or medical information we should know about your child

* I HEARBY AUTHORIZE EMERGENCY TREATMENT FOR THE ABOVE NAMED CHILD

* DATE OF AUTHORIZATION (today's date)

* I authorize New Hope Tutorials (tutors or staff) to dispense the following medications to my child at the child's request

ALLERGY ALERT SECTION

* Does your child suffer any serious allergies?

Yes, life-threatening

Yes, minor

Other

If your child has an allergy (foods, seasonal, environmental, medications, etc.), please describe this in detail: The elements that trigger the allergic reaction, what the reaction will look like, and any information New Hope needs to know to respond appropriately.

IF YOUR CHILD'S ALLERGY REQUIRES RESPONSE WITH AN EPI-PEN, PLEASE PROVIDE NEW HOPE WITH AN EPIPEN PACK TO ENSURE THAT TWO ARE AVAILABLE IN THE EVENT OF AN EMERGENCY (currently recommended by medical authorities).

PLEASE NOTE: If your child's allergy includes sensitivities to air-borne particles, please know that New Hope cannot ensure your child's safety at our facility, but we will inform the community to assist.

LAST STEP: Mail your full payment (for Minis or for Workshop) to:

New Hope Tutorials, Inc.
P.O. Box 1133
Middleton, MA 01949

*The only time New Hope will refund your workshop/MiniTutorial fee is if New Hope cancels all the selections you have registered for, e.g. because of low enrollment or loss of a tutor.

Check number:

Date check has been mailed:

Thank you for completing the registration process.

If you have any questions or concerns, contact New Hope Director, Joan Smith at joan.smith@newhopetutorials.org.

* Indicates Response Required

New Hope Tutorials www.newhopetutorials.org PO Box 1133 Middleton MA 978-750-3633