(Register) K-12 Summer Program

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Name of Program Location

(Parents/Guardian) First name

(Parents/Guardian/) Last name

(Parent/Guardian) Address

(Parents/Guardian/) Email

(Parents/Guardian) Phone

Does your child have a special education plan, individual education plan (IEP), or 504 plan as a part of their school’s education?

Race *

American Indian/Alaska Native

Asian

Hispanic

Multi-Racial

Black

White

Arabic

Other

Language Spoken In The Home *

English

Spanish

Arabic

French

Chinese

Other

What is your child's gender?

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