Explorers Hybrid Program at Anchored
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Email Address *
Student's Name *
Student's Date of Birth *
Gender *
Parent's Name *
Parent's Phone Number *
Address *
Student's Grade Level for 2024/25 school year *
List any schools or daycares the student has attended. (N/A for none)  *
Share a little about the student. What are their interests and hobbies?
Share any difficulties the student has. 
What is the student's learning style? 
Any health concerns we need to be aware of? (medical, allergies). 
Other concerns or important information? (n/a if none) 
Completing this form does not signify enrollment in our Explorer's program. If your student is a suitable candidate for our program, you will receive an email (at the provided email address) inviting you to a one-on-one meeting with the Explorer's staff, along with the parents and student.  
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