Summer Bootcamp Registration Form

Name of Current School*
Grade Entering for 2025-2026 School Year *
Sessions Per Week*
Summer Bootcamp Sessions Availability *

Monday (Winter Haven - AM or Bartow - PM)Tuesday (Lakeland - AM)Wednesday (Winter Haven - AM or Bartow - PM)Thursday (Lakeland - AM)Friday
Desired areas of focus. Ex: Phonics, Fluency, Writing, Reading Fluency, Reading Comprehension Strategies, Math, etc. *
Please list any allergies you child may have.*
Please tell me your about your child's favorite color, animal, hobbies, places to go/visit for fun.*
Additional Comments or Questions:

Tutoring Session Requested:*

Summer Bootcamp Session/Individual ($40.00/Hourly/Self-Pay)Summer Bootcamp Session/Individual ($45.00/Hourly/Step-Up for Students Scholarship)Summer Bootcamp Sesson/Small Group of 2-3 Students ($30.00/Hourly)
Preferred Payment Cycle:*
After registration is complete, there are additional documents that must be reviewed and signed in person.*
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This fee is comprised of the registration fee, deposit and supplies/materials fee. Please note that this fee must be paid prior to tutoring services starting. Parents determine the start date.

$25.00 Quantity
Item subtotal:$0.00

Total

$0.00
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The Scribble Room Registration Form