Interest Form

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Interest Form

Savage Learning Environment - Spring 2024

Parents/Guardians names *

Emails *

Phone Numbers *

Address(es) *

Child's Name and Age (Child 1) *

Child's Birthdate (Child 1) *

YYYY

What are some things that you would like us to know about your child (#1)? *

Child's Name and Age (Child 2)

Child's Birthdate (Child 2)

YYYY

What are some things that you would like us to know about your child (#2)?

Child's Name and Age (Child 3)

Child's Birthdate (Child 3)

YYYY

What are some things that you would like us to know about your child (#3)?

We encourage your child(ren) to join in as many club meetings as you see fit for your family. Which club(s) and day(s) are they interested in participating? *

Vibrant Mathematics - Wednesdays 9 - 11am

Black Literacy - Wednesdays 12 - 2pm

Arts and Activism - Thursdays 9 - 11am

Arts and Literacy - Thursdays 12 - 2pm

Individualized Learning Partnership - to be scheduled with your family

Coaching Sessions for Parents/Caregivers - to be scheduled with your family

Other:

Required

What allergies and/or food restrictions would you like us to be aware of?
*

We believe in flexibly flowing with the changing rhythms of life. We also cherish the opportunity to build trusting relationships with each family. In the spirit of balancing flexibility with trust, we would like to clarify our administrative needs, and we ask for your agreement (PLEASE CHECK EACH BOX TO SIGNIFY THAT YOU UNDERSTAND AND AGREE):

24-HOUR ADVANCE SIGN UP: I agree to send payment to SLE at least 24 hours before a scheduled meeting. I understand that if SLE does not receive my payment by then, the facilitators will assume that my family is not signed up for that scheduled meeting. Payment will serve as confirmation to the facilitators that they can make thoughtful preparations to support my children on the scheduled date.

24-HOUR ADVANCE CANCELLATION: I agree to communicate any necessary cancellation with at least 24 hours notice. I understand that late cancellations will not be refunded or rescheduled.

DROP OFF AND PICK UP: I agree to drop my child(ren) off no earlier than 10 minutes before a club meeting, and to pick them up at the end of the club meeting. I understand that prompt pickup allows for the facilitators to carry on with their responsibilities.

We will personally contact you upon receiving your completed interest form. Sign-up and payment details will then be sent to you What will be your preferred form of payment?
*

Charter School Purchase Order - Blueridge Academy

Charter School Purchase Order - iLEAD Exploration

Charter School Purchase Order - Sky Mountain

Charter School Purchase Order - EPIC Charter Schools

Venmo

CashApp

Paypal

Zelle

Cash

Check

How did you find out about Savage Learning Environment? What is drawing you to us? (Please feel free to be real and honest!)
*

What thoughts and questions do you have for us?
*

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