Parent/Guardian Information

Name

Email

Phone Number

Home Address

Preferred Contact Method

Phone
Email
Text

Student Information

Student Name

Grade Level

Date of Birth

Learning Preferences/Special Needs

Course Preferences

Please select the subjects or courses your student(s) are interested in. Course availability may vary based on enrollment.

Math Enrichment
Science Exploration
Reading and Literature
Creative Writing
Art and Design
Coding Basics

Technology Access

To participate in virtual classes, students will need reliable internet access and a device. Please confirm your setup below:

Device Available

Laptop
Tablet
Desktop

Internet Connection

High Speed
Moderate
Limited

Platform Familiarity

Zoom
Google Classroom
Microsoft Teams

Parent Involvement

Parental support enhances the virtual learning experience. Let us know if you’d like to assist in any capacity:

Monitoring student progress
Providing feedback on courses
Organizing virtual meet-ups

Emergency Contact

Name

Relation to Student

Phone Number

Upload Supporting Files

Upload any relevant files, such as photos or documents

Additional Information

Please share any other details or questions that may help us make this summer successful for your student:

Parent/Guardian Signature

By signing below, I consent to my student’s participation in the Virtual Summer School program and agree to adhere to the guidelines provided.

Name:

Date:

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