Contact Information
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Last Name
Address
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Cell Phone
Email Address
Emergency Contact Name and Emergency Contact Phone
Demographic Information
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Native Language
Date of Birth
Age
Employment Information
If yes, where do you work?
Learning Goals
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I would like to particpate in:
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Other Information
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Learner Agreement
The focus of The Literacy Center (TLC) is to improve adult literacy. TLC is a substance-free environment. Unfortunately, TLC does not offer childcare and is not equipped to accommodate children.
TLC adult learners are expected:
• To maintain consistent attendance when assigned to a specific TLC program/s.
Please abide by the following TLC policies:
•TLC is not liable for children. Children are never to be left without a parent or guardian.
I acknowledge I have read and I accept the above TLC expectations and policies:
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Date
If learner is younger than 18 years of age, parent/guardian signature is required below.
Print First & Last Name of Parent/Guardian
Date
Please initial and date below if you give The Literacy Center permission to use written comments or take a photo/video of you for promotional material or publication.
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