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2020-2021 HPA's Summer Activities Registration
Please use this form to register for our summer activities. More information about the available activities can be found at our website (
https://www.havasuprepele.com/summer-at-hpa.html
)
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* Indicates required question
Email
*
Your email
STUDENT INFORMATION
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
Student's Middle Name
Your answer
Current Student Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Grade level next school year
*
Choose
Kinder
1
2
3
4
5
6
7
8
Student's Gender
*
Choose
Female
Male
Other
Student's Email Address
Your answer
Student's Cell Number
Your answer
What school did the student attend last school year?
*
Havasu Preparatory Academy
Did not attend school last year
Other:
School Location (City, State, Zip Code, if known)
Your answer
OTHER INFORMATION
What school is the student planning on attending during the 2020-2021 school year?
*
Havasu Preparatory Academy
Other:
Which summer session are you going to attend? First choice.
*
Please pick one
Fun in the Summer with Pete the Cat (Story time and activities for students entering kindergarten.)
Future Hawks Club (Choice board activities for June & July. Google Hangouts in July)
Summer Writing Adventure (Students will have an opportunity to work on their creative writing skills, learn some tips & tricks, and create excellent stories.)
Learn Spanish with Carlesso (Learn basic Spanish with Mr. Carlesso.)
Lego Builders Club (Students are presented a challenge and given an opportunity to share their creations.)
COOL Kids Club (Social & Emotional Learning Program)
Required
Would you like to sign up for more than one session? Second choice.
Please pick one
Fun in the Summer with Pete the Cat (Story time and activities for students entering kindergarten.)
Future Hawks Club (Choice board activities for June & July. Google Hangouts in July)
Summer Writing Adventure (Students will have an opportunity to work on their creative writing skills, learn some tips & tricks, and create excellent stories.)
Learn Spanish with Carlesso (Learn basic Spanish with Mr. Carlesso.)
Lego Builders Club (Students are presented a challenge and given an opportunity to share their creations.)
COOL Kids Club (Social & Emotional Learning Program)
Would you like to sign up for more than one session? Third choice.
Please pick one
Fun in the Summer with Pete the Cat (Story time and activities for students entering kindergarten.)
Future Hawks Club (Choice board activities for June & July. Google Hangouts in July)
Summer Writing Adventure (Students will have an opportunity to work on their creative writing skills, learn some tips & tricks, and create excellent stories.)
Learn Spanish with Carlesso (Learn basic Spanish with Mr. Carlesso.)
Lego Builders Club (Students are presented a challenge and given an opportunity to share their creations.)
COOL Kids Club (Social & Emotional Learning Program)
PARENT/GUARDIAN/ADULT INFORMATION
Primary Contact: Name (Last, First)
*
This person should be the student's legal guardian. If 18 or older, the student is the primary contact
Your answer
Primary Contact Relationship
*
Select the relationship the person listed above has with the student.
Choose
Self (18+year old student)
Mother
Father
Aunt
Uncle
Grandmother
Grandfather
Sister
Brother
Spouse
In-Law
Guardian
Other
Responsibility the primary contact has over the student. Check all that apply.
*
Legal Custody
Lives with
Receives Mailings
Required
Primary Contact Street Address
*
Include Apartment/lot number if applicable. Any materials from the school will be mailed to this addess.
Your answer
Primary Contact City
*
Your answer
Primary Contact State
*
AZ
Other:
Primary Contact Zip Code
*
Your answer
Primary Contact Home Phone Number
Enter "NA" if you do not have a home number
Your answer
Primary Contact Cell Phone Number
Enter "NA" if you do not have a cell number
Your answer
Primary Contact Work Phone Number
Enter "NA" if you do not have a work number
Your answer
Primary Contact Email Address
This is helpful if you would like for teachers to correspond via email. (Enter "NA" if you do not have an email address)
Your answer
Would you like to add a Secondary Contact
*
Would you like to enter a secondary contact? This person is someone that shares custody of the student or someone who will share responsibility of dealing with school concerns.
Yes
No
Emergency Contacts (Optional)
IN CASE OF EMERGENCY NAMES OF PERSONS OTHER THAN PARENTS WHO CAN ASSUME TEMPORARY RESPONSIBILITY
Emergency Contact 1 Name (Last, First)
*
Your answer
Emergency Contact 1 Contact Relationship
*
Select the relationship the person listed above has with the student.
Choose
Family Friend
Aunt
Uncle
Grandmother
Grandfather
Sister
Brother
Spouse
In-Law
Guardian
Other
Emergency Contact 1 Primary Phone Number
Your answer
Emergency Contact 2 Name (Last, First)
*
Your answer
Emergency Contact 2 Contact Relationship
*
Select the relationship the person listed above has with the student.
Choose
Family Friend
Aunt
Uncle
Grandmother
Grandfather
Sister
Brother
Spouse
In-Law
Guardian
Other
Emergency Contact 2 Primary Phone Number
Your answer
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