2025 PRSD Summer Learning Program Registration

PARENT | GUARDIAN & ATTENDEE INFORMATION
Parent | Guardian Name*

First NameLast Name
Attendee Name*

First NameLast Name
Parent | Guardian Email*
example@example.com
Attendee Email
example@example.com
Parent | Guardian Phone Number*
Please enter a valid phone number.
Attendee Phone Number
Please enter a valid phone number.
Please enter grade level for FALL 2025*
Panther Program disabled

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Main Household Address*

Street Address

Street Address Line 2

CityState

Zip Code
If your child has an allergy or medical condition that staff should be aware of please indicate here.

Video and Visual Art Registration (see website for program details)
Video Production & Video Game Modding Sessions 12:30 - 4:30pm Instructor Steve Bartholomew
Visual Art Sessions 12:30 - 4:30pm Instructor Marcia Nadeau
Video Production Session(s) Total
Visual Art 2D/3D Session(s) Total

Rules & Policies

Parent/Guardian and Student/Attendee, please review, sign and date below to acknowledge that you agree and will abide by these expectations.
PARENT | GUARDIAN
Review Summer program expectations HERE
STUDENT | ATTENDEE
Review Summer program expectations HERE
Parent / Guardian Signature*

Clear
Student / Attendee Signature*

Clear
Payment
Total cost for all sessions
1. Pay for Sessions or Hours HERE

2. Upload receipt of payment (screenshot, snapshot image, etc.) below.

3. Once you have completed the steps in the process (application, payment, and UPLOADED PAYMENT RECEIPT), press SUBMIT.

4. You will receive email confirmation of your registration.
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Contact Information