Summer Learning Experiences

1

Parent Name* This field is required.

First Name

Last Name

2

Parent Email* This field is required.

example@example.com

3

Parent Phone Number* This field is required.

Please enter a valid phone number.

4

What is your current Learning Lab Wichita membership status?Please select the option that best describes your household’s membership status. Learning Lab Wichita staff will review responses for accuracy. Membership status is used solely to determine applicable pricing within payment plans and does not impact student registration priority or availability.

Member

Nonmember

I am interested in learning more about membership opportunities and discounted rates.

5

Student Name* This field is required.Please complete individual submissions for each student.

First Name

Last Name

6

What age is your student?

7

What learning level is your student enrolling in?* This field is required.Help us provide the best class recommendations for your student.

K-2nd Grades

3-5th Grades

6-8th Grades

8

I would like to enroll my student in the following summer learning experiences:Please select all that apply. Program details can be found on the Learning Lab Wichita program and event webpages.

(June 1-5) Food Forward: Science, Movement, and Culinary Creativity $225 (Members), $250 (Nonmembers)

(June 8 - 12) Creators and Changemakers $225 (Members), $250 (Nonmembers)

(June 15 - 19) Global Grooves: Music, Art, and Culture Around the World $225 (Members), $250 (Nonmembers)

(June 22 - 26) Future Builders of Wichita $225 (Members), $250 (Nonmembers)

9

Will your student require Early-bird drop-off?* This field is required.Early Bird Drop-Off is available from 8:00–9:00 A.M. for $5 per student per day. Regular drop-off is scheduled from 8:45 - 9:00 A.M.

YESNO

10

Which mornings will your student need Early-Bird drop-off?Please select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

11

Will your student require After-Care? * This field is required.After-care is available from 4:00–5:00 P.M. for $5 per student per day. A late fee of $5 will be applied for any learner not picked up by 4:30 p.m.

YESNO

12

Which evenings will your student require After-Care?Please select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

13

Is there anything we should know to best support your child?* This field is required.Please share any dietary needs, allergies, behavioral supports, routines, sensitivities, or strategies that help your child feel successful and safe.

14

How would you like to receive your payment details?* This field is required.Note: A student must be registered in 2 or more Summer Learning Experiences to qualify for a payment plan. A $50 deposit is required to secure your learner’s summer learning experiences by the registration deadline of May 22, 11:59 p.m. Regardless of whether you choose to pay in full or through a monthly payment plan, the full or final installment is due by May 23.

Payment in Full

Monthly Payment Plan

15

By completing and submitting this Summer Learning Experiences registration form, you are agreeing to our participant release, participant policies, and social contract.Please review each linked document before continuing.

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16

By completing and submitting this Summer Learning Experiences registration form, I acknowledge that my schedule requests will be reviewed by Learning Lab Wichita staff. Following review, a contract outlining payment options, deposit requirements, and additional details will be sent directly to me for confirmation. Submission of this form indicates my understanding that my learner’s participation is not finalized until the contract is completed and required payment or a one-time nonrefundable deposit has been received.

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