Literacy Lab: Registration

Classroom Teacher’s Name: *

Contact Email: *

Confirm Contact Email: *

Cell: *

Classroom Phone: *

Students’ age range: *

School/Site: *

Site Director/Principal’s Name: *

I certify that I will obtain my principal/site director’s permission before the program begins. I will let them know that the teaching artists in my classroom have a fingerprint clearance card. *

 YES

 NO

Do you have an assistant teacher joining you?: *

 YES

 NO

Assistant Teacher Name:

Assistant Teacher Email:

Confirm Assistant Teacher Email:

Date of your last day of school: *

Time that your school day ends: *

Where are you located? *

East Valley West Valley

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