Summer Bridge Program Registration
Student Information:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Number
*
Parent E-mail
*
example@example.com
Student Number
*
Student E-mail
example@example.com
How did you hear about us?
*
Please Select
Newspaper
Internet
referral
Other
Please Specify
*
What school will your student attend during the 2026-2027 school year?
What grade will your student be in during the 2026-2027 school year?
Please Select
9th Grade
10th Grade
Which school did your child attend this past school year? If multiple, please write the school where they ended the year.
Please share the ZIP code of the school your child attends. If multiple, please write the ZIP code where they ended the year.
Racial and/or Ethnic Identity
Please Select
American Indian, Indigenous, Native American, or Alaskan Native
Black or African-American
Asian or Asian-American
Hispanic or Latinx and any race
White or Caucasian
Native Hawaiian or Pacific Islander
Multiracial
Other (Please specify)
Prefer not to answer
Is your child an English learner or English as a second language student?
Please Select
Yes
No
Not Sure
Prefer not to answer
Does your child have a special education plan, individual education plan (IEP), 504 plan or they require specific learning accommodations as a part of their school’s education?
Please Select
Yes
No
Not sure
Prefer not to answer
Gender
Please Select
Male
Female
Non - Binary
Prefer not to answer
At school, is your family eligible to receive free lunch?
Please Select
Yes
No
Not Sure
Did your child attend a Summer Discovery program last year (2025)?
Please Select
Yes
No
Not Sure
Students who register for Summer Discovery programming must commit to attending programming throughout the summer. Summer Discovery is not a drop-in program, and it’s important for students to attend daily to receive the full benefits of the program. Will your student be able to attend at least 70% of the summer program days?For example, If a program is 20 days, a student would be expected to attend 14 or more of those days (70% attendance). If a program is 25 days, a student would be expected to attend 18 or more of those days (70% attendance).
Please Select
Yes
No
Important Information:
Along with assessments, students in rising grades 3-10 will be asked to complete a post-survey after the program so that we can evaluate any program-related successes and challenges this year in order to continue to improve Summer Discovery to best serve all students and families. No further action is required to provide consent for your child to participate. If you would prefer that your child not participate, please notify Mr. Mostyn confirming you would like to opt-out of student surveys.”
By submitting this enrollment application, I, the parent/guardian, consent to be contacted by Summer Discovery administration and/or service providers.
I consent
Submit
Should be Empty: