This program is made possible by a generous grant from the Vela Education Fund.
Student Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade (during the 2021-22 School Year--these programs are for 5th to 10th graders) *
Your answer
Parent Name *
Your answer
Parent Email Address *
Your answer
Parent Mobile Phone *
Your answer
Home Address--Street *
Your answer
Home Address--City, State, Zip Code *
Your answer
Program(s) Registering For (Register for 1 to 3 classes) *
Required
What COVID vaccination level does your child have? *
Required
I understand and agree that if my child presents COVID symptoms or if my child is unvaccinated, they may be rapid tested at the program. *
I understand and agree that masks may be required while at Longview School. *
I will be paying $240 per class by (space in classes is held once payment is received) ($40 discount for Minecraft class if you will be bringing your own laptop [NOT Chromebook]) *
Required
A copy of your responses will be emailed to the address you provided.