Summer Program Registration Request

1

Parent/Guardian Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Child's Name* This field is required.

First Name

Last Name

5

Child's Grade (in September 2026)* This field is required.

6

What would you like your child to build this summer?* This field is required.(Select all that apply)

Confidence in learning

Reading skills

Math skills

Focus and independence

School readiness

Maintaining momentum

Enrichment

Social confidence

7

Which pathway interests you most?* This field is required.

Bright Start (Entering JK)

Little Learners (SK - Grade 1)

Head Start (Grades 1-8)

I'd like help choosing

8

Which session timing are you most interested in?* This field is required.

July

August

Both

9

Are you interested in learning about 1:1 Intensive support as well?

Yes

No

10

Tell us anything you'd like us to know about your childExamples: Current goals, interests, or areas where support may be helpful.