R.E.A.L. – Reaching Everyone At Their Level Summer & After School Interest Form

R.E.A.L. – Reaching Everyone At Their Level Summer & After School Interest Form

Please fill out the form to express your interest and provide essential details for enrollment. Camp Dates June 1st - July 23rd weekly
Parent / Guardian Information
Parent/Guardian Name*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
CallTextEmail
Student Information
Student Name*
Age*
Program Role
Youth Participant (K-2nd)Student Participant (3rd–8th Grade)Youth Leader (9th–12th Grade)
Grade Level
k1st2nd3rd4th5th7th8th
9th10th11th12th
Program Selection
Summer ProgramAfter School ProgramBoth
Area of Focus
FootballBasketballAgility
DanceTheaterPoetry & Spoken Word
Cost Information
$125 Per Week
I understand the weekly costInterested in financial assistance
Preferred Learning Style
Sports-basedArts-basedGeneral
Schedule & Interest
Program Dates

Week 1: June 1 – June 4
Week 2: June 8 – June 11
Week 3: June 15 – June 18
Week 4: June 22 – June 25
Week 5: June 29 – July 2
Week 6: July 6 – July 9
Week 7: July 13 – July 16
Week 8: July 20 – July 23

Daily Schedule

Early Drop-Off: 7:30 – 8:29 AM (+$25)
Regular Drop-Off: 8:30 – 9:15 AM
Pick-Up: 2:00 – 2:30 PM
Late Pick-Up Fee: $25
Full-TimePart-Time
Acknowledgment
This is an interest form only (not guaranteed enrollment)I would like updates
Additional Questions
What are your child’s strengths/interests?
What would you like your child to gain?
Additional questions/comments
Signature
Signature*

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Date*

MonthDayYear
Date
Contact Information
Phone: (850) 777-4550
Email: info@heartoftheyouth.org
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R.E.A.L. – Reaching Everyone At Their Level Summer & After School Interest Form

Parent / Guardian Information

Student Information

Program Role

Grade Level

Program Selection

Area of Focus

Cost Information

Preferred Learning Style

Schedule & Interest

Acknowledgment

Additional Questions

Signature

Contact Information