Registration Form
Please fill out one form per child!
Sign in to Google to save your progress. Learn more
Email *
Parent/Guardian(s) First & Last Name *
Parent/Guardian(s) Email(s) *
Family Address *
City, State, Zip *
Parent/Guardian Phone Number(s) *
Child First & Last Name *
Gender *
Date of Birth *
Grade (School Year 2020-21) *
School *
E-Learning Platform *
Week 1: September 8-11
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 2: September 14-18
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 3: September 21-25
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 4: September 28 - October 2
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 5: October 5-9
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 6: October 12-16
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 7: October 19-23
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 8: October 26-30
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 9: November 2-6
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 10: November 9-13
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 11: November 16-20
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 12: November 23-24
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
MONDAY
TUESDAY
Week 13: November 30-December 4
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 14: December 7-11
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Week 15: December 14-18
8:00am-3:00pm
9:00am-4:00pm
8:00am-12:00pm
12:00-4:00pm
FULL WEEK
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Emergency Contacts (In the event you or another parent/guardian cannot be reached ) *
Please list anyone who is authorized to pick up your child from the Learning Center. *
Please acknowledge: Payments are due on the Thursday prior to each week. We do require a credit card on file. If you want to pay by cash or check, payment is due the Wednesday before each week. If payment is not received, we will bill the card on file on Thursday when the billing is done. *
Required
There is a $100 non-refundable deposit for the Learning Center. Someone from our team will reach out to get your billing information once a spot is confirmed for your child. Spot will be held once billing information is collected and deposit is paid. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms