ReMoore-Mind Changers Summer Enrichment Program - 2026 Registration
Disclaimer: Registration has a fee of $30. Once this form is completed, this fee must be paid in full immediately, and provided through CashApp at $Rpelt1. For any questions or inquiries, please provide correspondence at remoorelearning@gmail.com or mindchangers1@gmail.com. If registering multiple students, please fill out the form for one student at a time!
Student Information
Student's Full Name:
*
Student's Age:
*
Student's Grade Level
*
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
Requested Learning Focus:
*
Math
Reading
Reading Comprehension
Writing
Other
(Optional) If "Other" was selected for Requested Learning Focus, what combination of options for Learning Focus do you need?
What are some of the student's hobbies?
*
Parent / Guardian Contact Info
Parent / Guardian Name:
*
First Name
Last Name
Parent / Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent / Guardian Email Address
*
example@example.com
Emergency Contact Info
Only fill out if different from Parent/Guardian contact information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: