2019 EXPLORE Programs

2019 EXPLORE Programs
Choose Your Location: *

Newton, MA Acton, MA Lexington, MA
Choose Your Program in Newton, MA *
Choose Your Program in Lexington, MA *
Choose Your Program in Acton, MA *
What Skills Are You Looking For Your Child To Improve?

Speaking Confidence Critical Thinking Argument Constructing Persuasive Writing Critical Reading Impromptu Speaking Familiarity With Current Events
First Parent Name *

First Name Last Name
Contact Email *
example@example.com
Contact Phone *

Area Code Phone Number
Second Parent Name

First Name Last Name
Contact Email
example@example.com
Contact Phone *

Area Code Phone Number
What Town do You Live In? *
Student Name *

First Name Last Name
Student Date of Birth *

Month Day Year
Date Date Picker Icon
What is your child's grade this school year (2018-2019)? *
What school will your child be attending next year?
Student Gender *

Male Female

Address *

How did you hear about us? *

From a Friend Google Search PTO email Camp Fair Guidance Counselor TimeOutNY Advertisement MommyPoppins Article Newspaper or Magazine Camp Directory Wechat Group
Who referred you?
Have you attended a Lumos program previously? *

Yes, Attended Summer Yes, Attended 2-day Workshop No
Has your child attended a debate tournament before? *

Yes No
Are there any students your child would like to be placed in the same class as?
What are your child's areas of interest or hobbies?
Do you have any additional information or requests for our staff?
Any allergies or health concerns our staff should be aware of?
Emergency Contact

First Name Last Name
Emergency Contact Cell

Area Code Phone Number
Are there any locations you wish we had?
If possible, please include emails for two teachers who will know the student's classroom behavior and learning style. We will send these teachers a quick survey to help us tailor our teaching to your child's needs and interests (optional).

If you have already registered your child for a different session and listed teachers' emails, please do not submit the teacher emails again – merely skip this section.
Teacher 1 Email
example@example.com
Teacher 2 Email
example@example.com
What is your child's T-shirt size *

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large
Credit Card *

When you enter promo code, use ALL CAPS and make sure you click "Apply" to confirm the promo code

EXPLORE - Regular Tuition $ 800.00

Enter coupon

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