2024 Job and Life Skills Summer Program Application for Emerging Learners
Please fill out this Form to APPLY for our  Summer Program. This application does not guarantee acceptance into the program; we review all applicants to ensure that we are an appropriate program for your young person. The information on this application is confidential.  You will be notified by email ASAP if accepted into the program.  
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Email *
We have a mandatory Orientation for parent/ guardians on Zoom. Which Orientation webinar do you plan to attend? *
You can choose to do all 3 weeks or 1 or 2 weeks  
Program is 10:00am-3:00pm 
Please let us know how which weeks you would like your child to attend?

 *
Required
Cost of Program is $100 per week.  We can accept payments or pay at once.  Let us know what you prefer? *
Will your child MISS any sessions? Please tell us any dates you anticipate missing for Vacations or previous plans? *
Participants will need to bring a lunch and beverage each day. We will provide snacks and water.  Please indicate you understand this. *
Name of Child *
Age of Child *
Diagnosis' (this is to ensure we are training our staff in understanding your child's needs-please be detailed) *
Would your child require medication (or rescue medication) while at the program? *
Last school they attended and grade completed *
Does your child have any allergies? *
Please select the educational or work experience that they have completed or will be starting (check all that apply) *
Required
What are they passionate about-tell us things they love to do, play or learn about? *
Have they stated what they would like to do as an adult?  A job, an activity or further education? *
Sensitive Topics or Triggers (things to avoid) *
Tell us how your child responds to frustrations and what works the best to calm and re-direct when upset *
Any other information you would like us to know about your child? (optional)
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