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Enriched Kids Outdoor Homeschool Program
SPRING HOMESCHOOL REGISTRATION
DAILY DROP IN REQUEST
9am-2pm
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Email
*
Your email
I am requesting my child to attend at the following location(s). Select all that apply.
*
Wednesday at Ellwood Mesa
Thursday at Steven's Park
Friday at Douglas Preserve
Required
Date(s) Requested
*
Your answer
Child Name
*
Your answer
Child Grade in 2021-22 School Year
*
Choose
1st
2nd
3rd
4th
5th
Other
Child Gender
*
Choose
Male
Female
Parent 1 Name (associated with email above)
*
Your answer
Parent 1 Phone
*
Your answer
Parent 2 Name
Your answer
Parent 2 Email
Your answer
Parent 2 Phone
Your answer
Additional people permitted to pick up
Your answer
Primary Residence Zip Code
Your answer
Does your child have any medical needs?
Your answer
List any dietary restrictions or preferences
Your answer
Describe your child's proficiency and interest in reading and writing
Your answer
What are your homeschooling values and/or what would you like to see your child gaining from this program?
Your answer
Number of additional siblings who will be enrolling this semester --> Please click "Submit Another Response" after submitting this form
1
2
3
My payment preference is to:
*
Pay in full and receive a $30 discount for the semester
Pay in three monthly installments
I will be paying monthly using Heartland funds
After submission, a payment link will be sent to your email within one business day. We will hold your spot for 48 hours after payment link is sent.
A copy of your responses will be emailed to the address you provided.
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