SMLGN Summer Academy Application

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About Academy:
SML Good Neighbors has been offering a summer academy program for middle school students since 2016. Our academy program aims to help students maintain their learning during the summer and be more prepared for the next school year. This summer our academy program will be focused on writing and theater. Students will write a collaborative book, adapt it to a play and perform it for our campers in our elementary program on the last day of the program. Students in our academy will also enjoy our afternoon enrichment activities in peaceful living, nature education and global education. Breakfast, lunch and snack will be provided daily. We also provide weekend bags every week with food and a new book. We provide these bags to all students regardless of need; if you don't need it or can't use the food, please feel free to share it with someone who does.

Who is eligible:
Students currently in 6th - 8th grades (rising 7th - rising 9th grades)

When & Where:
Franklin County Session:
8am - 3pm; May 31st - June 23rd; Monday - Thursday (closed May 30th for Memorial Day)
Dudley Elementary School
Wirtz, VA

Bedford County Session:
8am - 3pm; June 27 - July 21; Monday - Thursday* (closed on July 4th, opened Friday (July 8) of that week to make up for being closed on the 4th)
Moneta Elementary School
Moneta, VA

Cost:
All of our programs are FREE to the families we serve.

Transportation:
Families are responsible for providing their own transportation to and from academy each day. However, SML Good Neighbors is willing to help with the cost of transportation by providing a $25 Kroger gas card to each family upon request on the 2nd Thursday and 4th Thursday of the program. To receive a gas card, the student must have attended at least 6 days prior to the date of receiving the gas card.

Space is limited at each session. Completing the application is not a guarantee of admission. You will be contacted with confirmation of your child's registration or notification of being waitlisted. Thank you!

For more information about SML Good Neighbors, please visit www.smlgoodneighbors.org

If you need assistance completing the application or have questions, please contact director@smlgoodneighbors.org or call our office at 540-585-4912.

Email *

Student's First and Last Name *

In which County will your student attend the academy session? *

Student's Date of Birth *

YYYY

Student's 2021 - 2022 Grade *

Student's School *

Parent/Guardian First and Last Name(s) *

Home Address *

Cell Phone Number *

Secondary Phone Number *

Emergency Contact Name & Phone Number (if parent/guardian is not available) *

Does your student have any medical alerts, allergies or health concerns that we should know about? If so, please list them below. Please also list the name of your insurance carrier, ID number and preferred hospital in the event of a medical emergency. *

Is there anything else you would like us to know about your student?

Photos or Videos of my child can be used for publicity: *

Yes

Yes, but they may not be identified.

I, the parent/guardian undersigned, do hereby state that I have read and received a copy of the Discipline Policy; and I release SML Good Neighbors, Inc. from any and all claims for losses or articles and damages arising as a result of any accident, injury by the named child arising from participation in SML Good Neighbors activities. Further, should an injury or illness be sustained, I hereby authorize SML Good Neighbors to administer first aid, or seek medical attention, in the event that I, as parent or guardian, cannot be reached. BY TYPING MY NAME BELOW to serve as my electronic signature, I confirm the information contained on this form, approvals and consents are accurate and consent to the above stated. *

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