Free Virtual Summer School Registration Form

Please complete this form to register for our Virtual Summer School.
Parent/Guardian Information
Name
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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