Membership Interest Form
Thank you for your interest in Meadow View Learning. Requests will be processed in the order received.
Name of person filling out this form:
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First Name
Last Name
Email
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example@example.com
Phone Number
Please enter a valid phone number.
City/town of residence
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Please indicate which membership(s) you are interested in:
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Summer-Only Member - July only
Program Member - Full-Access (5 days: Mon-Fri)
Program Member - Enrichment (1 full day/week)
How did you hear about us? If referred by a specific person, please provide name.
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If you become a member, what do you hope to get out of membership/programs?
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Please list name(s) of child(ren), ages, birth month and year, and current grade levels.
Is there anything we would need to know about your child in regards to medical, behavioral, or emotional conditions/concerns/diagnoses?
We maintain a wholesome environment, with a modest dress code (no tank tops, bare midriffs, shoulder/back cutouts, images depicting violence, etc), and a zero-tolerance policy on profanity and aggression. Are you comfortable with these standards?
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Yes
No
Our environment is designed to encourage focus and hands-on learning. Personal electronics such as tracking/communication devices (ie smartwatches, phones, etc) or hand-held video games are not permitted in the classroom. If parents would like to check in on their child they are welcomed to call the office anytime during the day. Are you comfortable with this policy?
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The remaining questions apply to program memberships. If you are interested only in a summer-only membership, you may stop here.
We offer renewable 6-month memberships. Our memberships run July thru December, and January thru June. Please indicate your desired start date for membership.
Please describe your child's education/schooling up to this point.
How would you describe your child's social & emotional development?
Has your child been removed from a class/program for disciplinary issues? If yes please describe.
How much screen time, if any, is your child exposed to per day/week?
Does your child have regular chores around the house that they are expected to complete daily/weekly?
On average, how many minutes per day does your child read (or is s/he read to) at home?
We teach academics as well as character virtues such as responsibility, honesty, kindness, and accountability. We learn about natural consequences and sometimes this means a student will be expected to clean up a mess they have made, redo an incomplete assignment, or replace an item that was broken due to misuse. Are you comfortable with this accountability approach?
Yes
No
Do you support students spending time outside daily, regardless of the weather?
Yes
No
Each semester our member families support our program by fundraising, and also by committing to bring in items from our donation wish list by the first Friday of each semester. The combined total for both of these is approx $200-$250 per semester. Is this something you will be willing to take part in each semester/membership period?
Yes
No
Submit
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