New H.O.P.E. for the Future Summer Enrichment Program
Please complete the registration form for each of your children and we will be in touch with you to complete the registration process.

The program is for students in grades K-8 (children who have completed Kindergarten up to those that have completed 7th grade and are going to 8th grade), from 7:30 AM - 5:30 PM, and operates Monday through Friday, June 21 - August 20, 2021.

All information entered here will be kept confidential and shared only with necessary Program staff.
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Email *
STUDENT INFORMATION
Student Name *
Student Home Street Address *
City *
State *
Zip Code *
Student School *
Student Grade during 2020-2021 *
Student Grade as of September 2021 *
Student Age *
List any subjects where the student needs additional assistance. *
CONTACT INFORMATION
Parent/Guardian
Parent/Guardian Name *
Parent/Guardian Best Contact Phone Number *
Emergency Contact
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact Phone Number *
ADDITIONAL INFORMATION
Please list any allergies and/or medical conditions *
Physician Name *
Physician Phone Number *
Insurance Information *
How did you hear about the program? *
Include any other information you would like us to know about your child. (OPTIONAL)
A copy of your responses will be emailed to the address you provided.
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