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Summer Workshop Registration
Please fill out the following form for Momentum's summer programs.
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* Indicates required question
Email
*
Your email
Parent Name
*
Your answer
Student(s) Name
*
Your answer
Upcoming Grade
*
Your answer
Special Needs/Allergies/IEP/504
Your answer
Parent Phone Number (Emergency Contact)
*
Your answer
I consent to my child being photographed during workshop activities.
*
Yes
No
Which workshop(s) will your child attend?
*
K-2 Reading
K-2 Writing
K-2 Math
3-5 Reading
3-5 Writing
3-5 Math
6-12 Reading
6-12 Writing
6-12 Math
Required
Which weeks would you like to enroll your child? (minimum of two required)
*
Week 1 (June 22 - June 25)
Week 2 (June 29 - July 2)
Week 3 (July 6 - July 9)
Week 4 (July 13 - July 16)
Week 5 (July 20 - July 23)
Week 6 (July 27 - July 30)
All 6 weeks
Required
A Pre-assessment is required for all workshops. Please choose the date on which you are available for the free assessment. *we will contact you to arrange the time for that day*
*
June 1
June 2
June 3
June 4
June 5
June 6 (morning only)
June 8
June 9
June 10
June 11
June 12
June 13 (morning only)
Are you new to Momentum Tutoring?
If you are new to Momentum please take a moment, after submitting this form, to fill out the registration form on the Momentum Tutoring website. This will allow us to send invoices for summer.
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