Programs Application
Thank you for your interest in Brown Institute! This application is only used for our academic programs: tutoring, book club, Saturday Academy, etc.  

This application is not used for school enrollment. If you wish to enroll your child in our school, please go back to our website to complete our pre-registration form.

A member of our administrative team will contact you. 
Sign in to Google to save your progress. Learn more
Email *
Child's Information
The following questions pertain to the child being enrolled. If you have more than one child enrolling, please complete an application for each child.
Child's Full Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Gender *
Child's Grade Level  *
Primary Residence (Include city, state, & zip code) *
Parent's Information
The following questions pertain to the parent or guardian.
Parent # 1 Full Name *
Relationship to Child *
Resides at same address as child? *
Occupation *
Work Phone Number *
Cell Phone Number *
Email Address *
Parent # 2 Full Name
Relationship to Child
Resides at same address as child?
Clear selection
Occupation
Work Phone Number
Cell Phone Number
Email Address
Programs of Interest *
Required
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Brown Institute for Young Learners. Report Abuse
Google Forms