Spotlight Scholars Learning Pod 2025-2026!
Parent:
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First Name
Last Name
Parent Phone Number:
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Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Email:
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Name:
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First Name
Last Name
Student Birth Date:
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Month
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Day
Year
Date
Student Age:
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Student Grade:
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Grade level for 2022-2023 school year
Allergies/Medical Conditions:
List the allergy/condition and any special needs or instructions the co-op director and teachers need to be aware of.
Student Class Selections (listed by hour):
Full Time Enrollment 9:00AM-2:30PM
Academic Pod 9:00AM-11:30AM
Nature Pod 12:00PM-2:30PM
After-School Pod 3:00PM - 4:30PM
Allergies/Medical Conditions:
List the allergy/condition and any special needs or instructions the co-op director and teachers need to be aware of.
Step Up Scholarship Type?
PEP
Private School
Unique Abilities
Other
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Parent Signature:
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