Virtual Summer Reading Enrichment Clubs
Congratulations on deciding to prevent the SUMMER SLIDE! Thank you for assisting me with getting to know your child and your online learning needs! This personal information is for Educational Services use ONLY and will not be shared. If registering more than one child, please fill out a registration form for each child. Fill out this form and I'll notify you when enrollment opens for STEAM (Science, Technology, Engineering, Art, & Mathematics) Adventures 2023.
All fields marked with * are required and must be filled.
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
*
example@example.com
Child's Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Child's grade Fall 2023
*
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
Preferred Method of Contact
*
Phone Call
Text Message
Email
All of the above
What programs are you planning to enroll your child to?
*
Art- Finding the great artist in every child (Age 5-8)
Science- STEM Adventure (Age 9-11)
Reading Fluency Group Sessions (Age 5-8)
What is the usual time of day you prefer your child to participate?
*
Early Morning (10:00am-11:00am)
Late Morning (11:00am-12:00pm)
Afternoon (12:00pm-1:00pm)
Other
What would you like your child to achieve while participating in the Summer Clubs 2023 Online Learning Program?
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Tell me about you child's interests, hobbies, strengths, areas for growth, or anything else you would like to share.
*
How did you hear about me? If you heard about me from one of my current clients, please include their name. (You will both receive a discount.)
*
Submit
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