4R Legacy Future Leaders Academy (Pre-K–5th Grade)
Tuition-free, 10-month hybrid leadership and life skills program for Pre-K–5th grade students meeting every Monday from 6:00 PM–8:00 PM (August–May). Completing this registration does not guarantee acceptance; only a limited number of students will be selected for the Founding Cohort. Need-based scholarships are available. No child will be denied participation because of financial hardship.
Student Information
Student First Name
*
Student Last Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
Current Grade
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
School Name
School District
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Middle Name
Last Name
Relationship to Student
*
Please Select
Mother
Father
Guardian
Grandparent
Step-parent
Other
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student Profile
What are your child's strengths?
*
What would you like your child to gain from this academy?
*
Does your child have any allergies, medical conditions, or accommodations we should know about?
*
T-shirt Size
*
Please Select
Youth XS
Youth S
Youth M
Youth L
Youth XL
Does your child have access to a computer/tablet and internet for virtual sessions?
*
Yes
No
Permissions
Photo/Video Release
*
Yes
No
Can your child attend every Monday from 6:00 PM–8:00 PM?
*
Yes
Most Mondays
No
Will you commit to supporting your child's attendance throughout the 10-month program?
*
Yes
No
Electronic Signature (Parent/Guardian)
*
Registration
How did you hear about us?
Would you like to volunteer with 4R Legacy?
*
Yes
No
Submit Registration
I understand the academy is tuition-free and requires a one-time $75 Registration & Materials Fee upon acceptance.
*
I understand
I understand scholarships are available for families experiencing financial hardship.
*
I understand
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