Sign up For Building Blocks of Language

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Note: Your enrollment will not be confirmed until payment is received, either in the form of a Venmo payment for $100 deposit to @kirsten-stracke or a purchase order is received from your charter school.

Parent/Guardian Full NameParent/Guardian EmailParent/Guardian Phone NumberStudent Full NameStudent Date of BirthStudent Grade (or grade level equivalent)Home Address (optional)Emergency Contact NameEmergency Contact Phone NumberAllergies (food/environmental/medication), if anyMedical notes we should know (optional)Does your child have any learning differences/disabilities or accommodations that would help them succeed? (If yes, please describe briefly.)Is your child comfortable writing independently? (Yes/Somewhat/Not yet)List 2–3 interests or favorite topics of your child (sports, animals, hobbies, books, etc.)

Which Building Blocks of Language sessions (grades 3-4) would you like to sign up for?

All sessions are on Wednesdays from 10:15 AM - 11:45 AM at the Pleasant Hill Senior Center. Session 1
August 19, 26
September 2, 9, 16, 23, 30
$400Session 2
October 7, 14, 21, 28
November 4, 18, 25
$400Session 3
Christmas-Themed Session
December 2, 9, 16
$200Session 4
January 6, 13, 20, 27
February 3, 10, 17
$400Session 5
February 24
March 3, 17, 24, 31
April 2, 7, 14
$400Session 6
April 21, 28
May 5, 12, 19, 26
June 2
$400

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