General Public Summer Program 2024 Application

Eliot-Pearson Children's School Summer Program 2024 Application

Please submit your application by January 31, 2024
The Eliot-Pearson Children’s School offers a six-week Summer Program for children ages 4 to 7 years old.

Session 1: Monday, June 24th 2024 - Friday, July 12th 2024

Session 2: Monday, July 15th 2024 - Friday, August 2nd 2024

Half Day: 8:30AM - 12:30PM

Full Day: 8:30AM - 4:00PM
Summer Tuition Summary
Child's Information
Child's Name

First NameMiddle NameLast Name
Child's Birth Date

MonthDayYear
First Day of Summer Camp

MonthDayYear
Date
Age of Child 06/24/2024
Child's Gender
Child's Primary Language
Please list any additional languages your child speaks.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Eliot-Pearson Children's School connections (select all that apply)

Other
If other, please explain

Parent/Caregiver 1's Information
Parent/Caregiver 1's Name

First NameLast Name
Relationship to child
Email Address
example@example.com
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

First NameLast Name
Relationship to child
Email Address
example@example.com
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address, if different from child's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Summer Tuition Summary
Please select the sessions you would like your child to attend (you may choose both)
Please select the time you would like your child to attend Session 1
Please Select the time you would like your child to attend Session 2

Help us get to know your child

Please use these this section to introduce us to your child.
Help us understand your child. Please share your child’s personality, temperament, characteristics and/or interests.
Please list your child’s previous group experiences, include schools, play groups, weekend activities, or any other group setting)

How did you hear about Eliot-Pearson Children’s School? Please indicate where (name or publication)

Health Summary

Tell us about your child's medical history. Please upload any relevant documents.
Tell us about your child’s health. Has your child had any major health/developmental complications or challenges? Please share specifics: vision, hearing, walking, speaking, or attention? Other?
Has your child ever been evaluated or screened?
If yes, please share more information
Does your child have any medical conditions or allergies you would like us to aware of?
Does your child require medication to be kept at school (medication, epipen, inhaler etc.)
Please upload any relevant health documentation.

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Please upload any relevant health documentation.

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Please upload any relevant health documentation.

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Demographic Information

We offer you the option to share the following information with us. No individual family selections are made based on this information. There will be no impact on your application based on your answers.
Racial Identity
Ethnic/Cultural Identity
National Origin
Religious Identity
Select ALL applicable identities
Other Identities

Please check all the boxes and sign below
My signature indicates my understanding and agreement with the above statements.

Payment
Please press submit to complete your summer program application and pay the $200 enrollment deposit.

If your child is not accepted to the program your deposit will be refunded. If your child is accepted it will be credited towards your tuition. Please submit this payment by January 31, 2024.
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Eliot-Pearson Children's School Summer Program 2024 Application