Inspire A Learner Registration
At Inspire A Learner, we leverage the Eid Method. Eid, which means celebration in Arabic, captures how Inspire A Learner celebrates religion, faith, and language in all our lessons! Please complete the registration information below to ensure your child has a space at Inspire A Learner. In addition, we ask that you verify your child's medical needs.
General Information
Student Name
First Name
Last Name
Grade/Age
Preferred Start Date
-
Month
-
Day
Year
Date
Preferred Timeslots (Weekdays)
Full Day (9 AM – 3 PM)
Half Day (9 AM – 12 PM)
Extended Day (8 AM – 5 PM)
Other
Parent Name
First Name
Last Name
Email Address
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Emergency Contact Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Relationship to Student
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Food Allergy Information
“Severe food allergy” means a dangerous or life-threatening reaction of the human body to a food-borne allergen introduced by inhalation, ingestion, or skin contact that required immediate medical attention. Please list any foods to which your child is allergic or severely allergic, as well as the nature of your child’s allergic reaction to the food.
Food Allergy Information
No food allergy to report?
Yes
Submit
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