Application Form: ‘Primary Matters’ Summer School at Renaissance College
Name of student:
Age/ Year / School:
Parents’ Names:
Home Address:
E-mail Address:
______________________________________(must include)
Important Telephone Numbers
Home:
Mother
Father
Mobile:
Mother
Father
Helper
Course/ courses requested (include the Block, Course Number and the title of the
course):
If you are applying for a Writing about Reading Course,’ and your child has attended this
course in a previous year please note the title of the book your child studied:
Does your child have any reading/writing writing difficulties? Is he/she on an IEP?
Does your child have behavioural issues?