Fountain Learning Center Summer Registration form

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Basic information and registration form for the Summer 2023 school year at the Fountain Learning Center, an in home, independent, and private educational program. This is for information purposes only. It is not a contract or a guarantee of enrollment (please see the contract sent separately)

Your first and last name *

Your student's first and last name *

Students preferred name *

Please share any medical information I may need to know here. (allergies or other). If none please mark none. *

Age of your student *

Under 10 years old (at this time we are only set for 10 years and up. However if the interest is there we are open to setting this up)

Between 10 and 12

Between 13 and 15

Between 16 and 18

Mailing address *

Phone Number *

Email address *

What is your preferred method of contact? *

Phone

Text

What is most important to you about your student's education? *

What are your goals for your student's education? *

What can you tell me about how your student feels about learning, including what they like to learn about and how they like to learn. *

Please share any struggles, needs or barriers in your student's education. *

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