Summer School Registration Form

Summer School Registration Form

Please complete this form for each scholar you'd like to register.
Program begins July 6, 2026 and ends August 6, 2026. Program runs Monday-Thursday.
Student Full Name

First NameLast Name
Student Date of Birth

MonthDayYear
Date
Assigned Grade Level for 2026-2027 School Year
Allergies or Medical Conditions
Will your scholar require transportation services?
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Relationship to Student
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Signature
Should be Empty: