Summer New Student Interest Form

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We are so excited that you found us, and that you are interested in allowing us to provide an extra positive support for your child! Please share some basic information about your child so we can begin to know where your child might best fit in our program, and Director Tara Steiner will follow up soon! Once I have your child's basic background and your contact information from this form, you will have a spot reserved on the waiting list and will be contacted when we have new class spots to offer during the coming year. Even if your summer schedule is too full and you are interested in enrolling for classes starting in the fall, it is important to reserve your child a spot on the waiting list NOW to ensure a first chance when those classes open--if waiting for a certain season is your preference just indicate that on the form as well! Thank you!

Child's NAME and AGE

Birthdate

YYYY

Parent/Guardian Name(s) and Relationship to Child *

Email *

Phone number

Briefly explain how your child fits with the mission and target group for our program, and why you believe your child could benefit from the extra support of a program like Stirrup Courage. What would you say are some of your child's biggest challenges/obstacles to overcome currently? *

Looking at your summer schedule, please check ALL possible days/times in June/July that would generally work best for someone in your family to transport your child to lessons. Providing all possible options will help us in offering class options that will fit the most schedules when putting groups of children together. Most sessions will begin the first full week of June and run for all four weeks of June in a row. The second summer session will run the second half of July into August.

10:00-11:00am

1:00-2:00pm

2:00-3:00pm

3:00-4:00pm

4:00-5:00pm

6:00-7:00pm

7:00-8:00pm

Monday

Tuesday

Wednesday

Thursday

Friday

I am also looking at offering the option of a new student class that would run 4 days in a row for one week of the summer (July 8-11), for families who have busy summers and would like to get the class in all at once. If you would be interested in that option instead of a once-a week 4-week schedule, respond below with whether that would work best for a morning (10-11am) time or early afternoon (1 or 2pm) that week.

The cost of each 4-week session is $100. We ask all families to pay as much as they are able so we can sustain the program while serving as many children as possible, and offer scholarships to help cover costs that would be a barrier to participation for some families. Please respond if you will be requesting a scholarship, and in what amount, to help us anticipate our sponsorship funding needs. *

I am able to pay the full cost of the session.

I would be able to pay $75, and request a scholarship to cover $25

I would be able to pay $50, and request a scholarship to cover $50

I would be able to pay $25, and request a scholarship to cover $75

Our family's level of financial hardship would require a scholarship for the full amount in order to participate at this time.

Other:

Any other comments or information we should know? (Specific weeks/days of the summer child will be unavailable because of trips, camps, family vacation, etc. will be helpful!). Also let me know if you won't be available to start at the beginning of the summer but want to be on the list for later (for example, if you will be gone a lot in June, but would like to potentially start sessions in July/August, or your summer is too busy but you want to be on the list to start during the school year), so I know to keep you updated and save your child a spot on the list.

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