Student Interest Form
Share your interest in Laissez Fair Digital Academy, located in Maitland at the new PediaBloom location. Please complete this form so we can connect with you about our programs.
Parent Full Name
*
First Name
Last Name
Parent Email Address
*
example@example.com
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student Full Name
*
First Name
Last Name
Student Age
*
Student's Current Grade
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Scholarship Type
*
Which program(s) are you interested in?
*
TechQuest
CoreWorks
Both
social makers lab (month)
What days and times work best for your family?
*
Do you have any questions for the founder?
How did you hear about our program?
*
Please Select
Friend or Family
Social Media
Online Search
School or Teacher
Community Event
Other
$500 Materials fee for full-time labs schedule
Submit
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