Summer 2022 Workshop Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out the following form for Momentum's summer programs per child

Email *

Parent Name *

Student Name (One form per child) *

Upcoming Grade *

Special Needs/Allergies/IEP/504

Parent Phone Number (Emergency Contact) *

I consent to my child being photographed during workshop activities. *

Yes

Are you currently a client of Momentum Tutoring? *

Yes

Returning Client

Please select which Academic program(s) you would like to enroll in:

Reading

Writting

Math

Kindergarten - 2nd grade

3rd grade - 5th grade

6th grade and up

Which weeks would you like to enroll your child for the Academic programs? (minimum of two required)

Week 6 (July 25 - July 28)

All 6 weeks

Please select which elective class(s) you would like to enroll in:

Art Class 11am M/W

Art Class 1pm M/W

Spanish Class (K-2 Only) 2pm M/W

Fitness Class 11am T/TH

Fitness Class 1pm T/Th

Ukulele Class 2pm M/W

Which weeks would you like to enroll your child for the Elective classes? (minimum of two required)

Week 6 (July 25 - July 28)

All 6 weeks

Are you new to Momentum Tutoring?

If you are new to Momentum please take a moment, after submitting this form, to fill out the registration form on the Momentum Tutoring website. This will allow us to send invoices for summer.

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Momentum Tutoring. Report Abuse

Forms