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Please fill out and submit this form to register for a summer program!
5
Questions
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1
Student Name
*
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First Name
Last Name
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2
Grade range of child
*
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Grade 4
Grades 5-8
Grades 9-12
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3
Email
*
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example@example.com
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4
Which program are you interested in registering for?
*
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Literacy (fiction and non-fiction) 5-8
Accelerated (AP test prep) 9-12
Social Emotional Group Sessions
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5
My Products
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Great Product Name
$20
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Great Product Name
$20
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Great Product Name
$20
Quantity:
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Size:
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Great Product Name
$20
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ORDER SUMMARY
Total cost
USD
Literacy (Fiction and Non-fiction) 5-8
$
300.00
+
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Accelerated (AP Test Prep) 9-12
$
300.00
+
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Social/Emotional Group Sessions
$
300.00
+
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