KSPE Summer Learning Program Registration

Student Registration Form

Fill out the form to reserve your child's seat in the program. Each child must have a separate registration form.
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School attended in 2020-2021
School attended in 2019-2020
YesNo
If yes, please indicate sibling's name:
Parent/Guardian Information

NOTE: Additional parents/guardians can be added to the student's file after acceptance to the program.
Parent/Guardian #1

First NameLast Name
Parent/Guardian #1 E-mail
example@example.com
Parent/Guardian #1 Cell Number
Format: (000) 000-0000.
Parent/Guardian #1 Work Number
Format: (000) 000-0000.
YesNo
If no, please include address for Parent/Guardian #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2

First NameLast Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #2 Work Number
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
If no, please include address for Parent/Guardian #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contacts

NOTE: At least one required for registration. Additional contacts can be added later.
Emergency Contact #1

First NameLast Name
Emergency Contact #1 Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact #1 Email
example@example.com
grandparentother relativefamily friend
Emergency Contact #2

First NameLast Name
Emergency Contact #2 Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact #2 Email
example@example.com
grandparentother relativefamily friend
Other Information

Please complete with as much accuracy as possible. If any of the categories in this section are answered YES, a meeting with KSPE will be required before the student may begin the program so that we can best meet your child's educational needs.
Medical Concerns
If yes, briefly describe medical concerns:
Allergies
If yes, briefly describe allergies:
NoneLearning disabilitySpeech/language delayVisionHearingPhysical disabilityAttention issuesOther
If yes, briefly describe disabilities and necessary accommodations:
YesNo
Program Selection
Select Your Programs:*
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May 31-June 4: Insects (no meeting, Monday, May 31)
Students will become junior entomologists and learn about native insect species: their benefits to the environment, their life cycles, and other amazing facts. Hands on activities will include building a temporary insect habitat and observing and recording insect activity.

$120.00 Quantity



June 7-11: Graphic Novels
Some people call them comic books, but graphic novels are an important part of the reading landscape. Students will learn more about the genre and build their own graphic novels, from idea to finished product.

$150.00 Quantity



June 14-18: Photography
Students will become junior photographers this week, learning about photography history and basics of the craft. They will build their own pinhole cameras to capture the world around them.

$150.00 Quantity



June 21-25: Mapmaking
Students will learn about geography and navigation through the hands-on work of mapmaking. They will end the week with finished maps of important places in the world around them.

$150.00 Quantity



June 28-July 2: Radios & Technology (Holiday: July 1-2)
Students will learn the basics about amatuer radios, including appropriate on-air etiquette, the basics of radio technology, and a crash-course in other related technologies. Hands-on activities will include using an amateur radio under the supervision of their instructor.

$90.00 Quantity



July 5-9: Solving Crimes
Fabulous diamonds have been stolen, and students must become amateur detectives to solve this tricky crime. From fingerprint analysis to basic chemistry, they will learn how real-life detectives solve crimes.

$150.00 Quantity



July 12-16: Travel to France
This French-immersion week will allow students to learn about key destinations in France, planning a trip to their chosen locale, budgeting their money and planning their time. The Friday capstone will be a celebration of French culture. Bon voyage!

$150.00 Quantity



July 19-23: Dead Things
Students will learn about a key part of the life cycle of living creatures: death. In addition, students will learn about archeology and the study of cultures through the remains of humans, animals, and cultural objects. Activities include dissecting several creatures and learning about ancient Egyptian culture by mummifying a fish.

$150.00 Quantity



July 26-30: Run an Animal Shelter
Students will be tasked with setting up an animal shelter, learning about animal care, the need for shelters, and real-world skills such as budgeting and planning. They will adopt a (stuffed) animal from their shelter, and meet live animals that have benefited from the adoption process.

$150.00 Quantity



Aug 2-6: Theater
Students will be immersed in the bright lights of the theater as they plan and perform their own mini-production.

$150.00 Quantity



Aug 9-13: Sign Making
This hands-on arts and crafts week offers students the opportunity to learn about signs and their importance. From creating basic signage to helping plan and sew a banner, the students will gain plenty of hands-on experience producing their own signs.

$150.00 Quantity



OPTIONAL: Donation
Please consider adding a donation that will help offset KSPE's operating costs. KSPE is a nonprofit corporation in the State of Tennessee and a Category IV Church-related school under the umbrella of Tennessee Association of Church-Related Schools. Our IRS-designated EIN number is 85-2002126. We are awaiting final determination on our 501(c)3 status.

$25.00 Quantity



Total

$0.00
Choose your payment option:
NOTE: A minimum payment, according to your chosen payment option, is due before your child may start attending the Summer Learning Program. KSPE accepts checks, cashier's checks, and money orders. We cannot accept credit card payments or cash payments at this time.
I understand that before my child is enrolled in the course, I must sign a Summer Learning Program Contract and a Safety Contract, as well as provide an Immunization record for my child’s file, unless one is already on file.

I also understand that I must complete additional paperwork for my child’s file. This includes but is not limited to a signed and dated Summer Learning Program Parent Handbook Acknowledgement form.

I further understand that my child will be required to wear a mask during school hours. Failure to comply with this policy may result in dismissal from the program.
Initials*
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Student Registration Form

Parent/Guardian Information

Emergency Contacts

Other Information

Program Selection