NEW HOPE TUTORIALS

New Hope LEXINGTON REGISTRATION Packet: Includes tutorials selection, medical forms and Parent Contract.

WELCOME! You are invited to register for courses at New Hope Tutorials / Lexington, 2010.

**NEW OFFERINGS now available in this UPDATED REGISTRATION FORM!**

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

* Please visit our website to fill out our ONLINE ENROLLMENT form, which is required along with the interview.

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: Sign-up for Tutorials

New Hope accepts payments for the whole year, or quarterly or monthly. If you pay monthly, the total cost for the year will be divided over 10 months (September through June), with payment due by the first of each month.

Year-long Tutorial meets once a week for 1.5 hours: $72/month (for 10 months).
Year-long Tutorial meets twice a week for 1.5 hours: $145/month (for 10 months).

12-week Mini-Tutorials (Writing, Science, Art) 18 hours of academic instruction: $250.00 *******Register before September 1st and get $25 off ($225 total fee)

6-week Workshops (8-10 year olds) (1.5 hours per week): VALUE-PRICED at $75 each workshop!**********Register before September 1st and get $10 off ($65 each)

Mime Workshop for ages 11-18 (1.5 hours per week): $90 for 12 weeks ******** Reigster before September 1st and get $10 off ($80 total fee)

Please note: All tutorials require a minimum of six students. Tutorlals will not exceed 12 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 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 runs November 1 through December 6, MONDAYS only

THEME: FANTASY

Winter session runs February 28 through April 4, MONDAYS only

THEME: to be determined

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 Writing, 9:30-11:00 am/Mon (Fall session)

Pls sign me up now for Winter Session as well.

Fantasy Art, 11:15 am -12:45 pm/Mon (Fall session)

Pls sign me up now for Winter Session as well.

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, two or three subject areas. Each tutorial must have six students to run. Students enrolled in the fall session will have priority placement into the winter session. *Please note: MIME Workshop for this age group will be held on Mondays only.

Schedule for Minis in Art, Writing, and Science:

Fall session: Wed. September 22 through Wed. December 15 (12 weeks)

Winter session: Wed. January 19 through Wed. April 13 (12 weeks)

Mime workshop: Monday September 20 through Monday December 13 (12 weeks)

MINI Tutorial in ART fall session (11:15 am -12:45pm/Wed.)

Pls register me now for winter session as well

MINI Tutorial in SCIENCE fall session (1:15-2:45pm/Wed.)

Pls register me now for winter session as well

MINI Tutorial in WRITING fall session (3:00-4:30 pm on Wed.)

Pls register me now for winter session as well

Mime workshop "A" (11:15am-12:45pm/Mondays)

Mime workshop "B" (1:15-2:45pm/Mondays)

I wish New Hope would offer:

8th GRADE and HIGH SCHOOL TUTORIALS (13 year olds/14-18 year olds)

Some tutorials meet on Mondays AND Wednesdays; others meet one day only. *Please note: Mime workshop

for this age group will be held on Mondays.

Intermediate Literature & Writing (1:15-2:45 pm/M & W) (for 8th/9th grades)

American Literature & Writing (11:15 am-12:45 pm/M&W) (for high school ages)

Public Speaking (9:30 am-11:00 am/Mondays only) (8th grade/high school ages)

Art (9:30 am-11:00 am/Wed only) (8th grade/high school ages)

Mime Workshop "A" (11:15am-12:45pm/Mondays)

Mime Workshop "B" (1:15-2:45pm/Mondays)

I wish New Hope would offer

* I have done my best to avoid scheduling other commitments on New Hope days (Mondays and Wednesdays). I realize that accommodations for any conflicts on these days cannot be guaranteed.

Yes

The following represent potential day/time conflicts. I understand that New Hope will do its best to work around the following: travel time over 40 minutes, carpool commitments, and public school sports. I understand that accommodation of other commitments cannot be guaranteed. I have noted all my time constraints below.

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:

If you are registering for YEAR-LONG TUTORIALS, there is a registration fee of $225 that we ask you to mail in as soon as you register. $100 of this registration fee will be applied to your tuition.

If you are registering for MINI-TUTORIALS or WORKSHOPS, there is NO REGISTRATION FEE. However, we do ask that you submit full payment for the mini-tutorial or workshop as soon as you register.

THANK YOU!

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

$100 of your registration fee will be applied to your September tuition payment.

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

Check for $225 has been mailed

Check number:

Date check has been mailed:

Thank you for completing the registration process. We will place your child into requested tutorials, and mail a published schedule to you along with a PARENT CONTRACT for you to sign and mail back to New Hope Tutorials.

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