Pre-Consultation Form - Ready Minds Learning Academy

Child's name

First

Last

Child's Age

What grade is your child in?

If between grades, list the grade the player will be in at the start of the next school year.

Does your child have experience with online learning?

yes
no

What type of schooling has your child received?

What was your child's Language mark on the most recent report card?

Above Average (B+ to A+)
Average (C+ to B)
Slightly Below Average (C- to C)
Below Average (D- to D+)

Which of the following best describes your child?

My child is highly motivated.
My child is somewhat motivated, but needs rewards and incentives to stay motivated.
It is hard to motivate my child even with rewards and incentives.

Complete the following statement: My child usually stays focussed on a learning task…

Which of the following options best describes your child? Check all that apply.

My child enjoys video games and/or computer games.
My child enjoys doing learning activites with paper and pencil.
My child enjoys educational videos and T.V. shows.

Which of the following best describes your child?

My child enjoys reading.
My child does not enjoy reading, but likes when someone reads a story to them.
My child does not enjoy reading or listening to stories.

Has your child been formally diagnosed with a learning disability or neurodivergency (e.g., ADHD, Autism)?

yes
no

If you answered "yes" to the previous question, please provide details (e.g., (diagnosis, severe or mild, recommendations).

Is there any other information you would like to share about your child?

Parent/Guardian Name

First

Last

Parent/Guardian Email

Parent/Guardian Phone

Permission & Agreement

I agree and give my permission

I give permission for the tutor(s) at Ready Minds Learning Academy to assess my child’s reading ability. I will be present during the assessment, which will be conducted via a Zoom Video Meeting.