Summer Program 2025

Child's Name

First Name

Last Name

School:

Grade Level in 2025-2026 School Year

Reading Level

(A-Z if known)

Dates Requested

Please list the exact dates or date ranges you would like your child to attend. Please note that there is a minimum commitment of two days per week for three weeks.

Half Days (8am-1pm) or Full Days (8am-4pm) or Half Day Afternoon (1pm -4pm)?

Parent's/Guardian's Name

First Name

Last Name

Parent's/Guardian's Email Address

Parent's/Guardian's Phone Number

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