Student's Name *

First Name

Last Name

Parent's Name *

First Name

Last Name

Parent's Phone (cell preferred) *

(###)

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What grade will the applicant be entering in the fall of 2024? (Note that only students entering in Grades 6-10 in the fall may attend the program). *

Grade 6

Grade 7

Grade 8

Grade 9

Is the applicant currently attending a public school or public charter school? (Note that only students currently attending public or public charter schools may attend.)

Yes

No

Partial and full scholarships are available on a limited basis, and are specifically reserved for participants for whom the fee would prevent them from attending. Will you be seeking a partial or full scholarship for your child? If Yes, please email our scholarship coordinator, Dr. Aprille Ericsson, at: aprille.j.ericsson@gmail.com *

Yes

No

If your child does not have a device to use, would you like to loan a device from the program? (Note: There will be a $5 charge to cover insurance for the device for those who are loaned one.)

Yes

No

Check the box below to confirm you abide by the Parent Agreement *

I understand that if my child's behavior is undermining the experience of other participants at the camp, he or she will be asked to leave without a refund. I agree to ensure that my child will arrive at the Inspired Teaching Charter School campus promptly at 9:30 am each day and will be picked up at 2 pm sharp each day during the week of July 29-August 2nd. I have paid the registration fee of $50 (or requested financial aid).