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Club Limitless: Academic Adventures Spring 2025
The information provided will be kept confidential and will not be shared with any parties outside of Colorado Learning Connections. We respect your privacy and are committed to using your data solely for educational purposes within our organization.
Primary Parent/Guardian Name
*
First Name
Middle Name
Last Name
Primary Parent/Guardian Email
*
example@example.com
Primary Parent/Guardian Phone
*
Please enter a valid phone number.
Primary Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary Parent/Guardian Name
First Name
Middle Name
Last Name
Secondary Parent/Guardian Email
example@example.com
Secondary Parent/Guardian Phone
Please enter a valid phone number.
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Student Name
*
First Name
Middle Name
Last Name
Student Gender
*
Please Select
Male
Female
N/A
Student Birthdate
*
-
Month
-
Day
Year
Date
School
*
Please Select
Upper Blue Elementary (Mondays 3/3-4/14)
Breckenridge Elementary (Wednesdays 3/5-4/16)
Summit Cove Elementary (Mondays 4/28-6/2)
Frisco Elementary (Wednesdays 4/30-6/4)
Student Grade
*
Please Select
1st
2nd
3rd
4th
5th
Student Allergies
*
Is your student receiving any special education services (IEP, 504, or READ plan.) If yes, please send those plans to KaitlynH@CLCsummit.com so those accommodations and modifications can be applied to these lesson plans.
*
Please Select
IEP
504
READ Plan
None
If yes to the previous question, please provide any additional information that could be helpful when working with them such as diagnosis, strengths, weaknesses, goals, and how we can best support them.
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Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relation To Child
*
Emergency Contact Phone
*
Please enter a valid phone number.
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Submit
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