2025 LUMINA Center Rainbow Summer Registration Form * We will call you or you can call us to set up an appointment to come into the center to complete other forms and pay the fee for your child(ren) to attend!
$10 registration fee for each student
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Student Name (Last, First) *
Has your child been enrolled in any of our programs before? If no, there will be another form for you to fill out prior to Rainbow Summer. *
Grade for 2025-2026 school year  *
Gender *
Race *
Required
Does this student have therapeutic staff support/aide? *
Does student have an Access Card? *
Does student have any medical/emotional conditions, allergies- including food allergies- that we should be aware of? *
If you answered yes to the question above, please explain here: 
Is student taking any medications needing administered during the summer program hours? *
Check grade/session weeks student will be attending (grade they are going into): *
Required
How did you find out about our Summer Program? *
Are you interested in information about our Afterschool Program?  *
Handbook
Handbook link
You must indicate that you have read the handbook to move on in the registration process. 

 *
I, parent/guardian, of student named above, give permission for this student to participate in LUMINA Center's summer program and hereby release the LUMINA Center and all summer program teachers, counselors and staff members from all present or future claims, demands or suits arising from or in any way related to the LUMINA Center summer program. 

I understand that in the event of disruptive behavior, I may be contacted and asked to come and remove my student from the center. Also, I understand that my student may be banned from Center activities for a period of time deemed appropriate by Directors because of inappropriate and unacceptable behavior. 

By typing your name you are agreeing to the statement above:
 *
Phone number *
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