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Power Scholars Academy Application - Wyatt
Power Scholars Academy will help advance scholars' academic achievement through a full-day summer experience that combines small group rigorous academic instruction with fun, hands-on enrichment activities, field trips, and service projects. Power Scholars is open to current Kindergarten thru 8th grade scholars at Wyatt Academy.

Scholars must attend all day (8:00 am-3:30 pm), everyday, for the full six week program. Power Scholars starts on Monday, June 12 and ends on Friday, July 21 with our Brilliance Bash!

You must attend the Power Scholars Enrollment Session in order for your scholar to be accepted into the program. The Power Scholars Enrollment Event will take place on Saturday, May 20th (9:00 am-12:00 pm and 1:00-4:00 pm) at Wyatt Academy. Please come any time during one of those time windows and plan to stay for 45 minutes to complete enrollment. If you do not attend this event, your scholar will not be able to attend Power Scholars. Please email Tara Gannon, PSA Site Director, at tgannon@denverymca.org if you have any questions or are unable to send a family representative to this event. We look forward to the BEST SUMMER EVER with your scholar!

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Untitled Title
Date of Birth
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Gender
Current School
Current Grade
DPS ID # (Lunch #)
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Home/Mailing Address (number, street, apt #, city, state, zip code)
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Parent/Guardian #1 Name (Last, First)
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Parent/Guardian #1 Relationship to Child
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Parent/Guardian #1 Authorized to Pick-Up?
Parent/Guardian #1 Phone Number (Cell, Home, Work)
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Parent/Guardian #1 Email Address
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Parent/Guardian #2 Name (Last, First)
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Parent/Guardian #2 Relationship to Child
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Parent/Guardian #2 Authorized to Pick-Up?
Parent/Guardian #2 Phone Number (Cell, Home, Work)
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Parent/Guardian #2 Email Address
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Emergency Contact #1 Name (Last, First)
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Emergency Contact #1 Relationship to Child
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Emergency Contact #1 Phone Number (Cell, Home, Work)
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Emergency Contact #1 Authorized to Pick-Up?
Emergency Contact #2 Name (Last, First)
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Emergency Contact #2 Relationship to Child
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Emergency Contact #2 Phone Number (Cell, Home, Work)
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Emergency Contact #2 Authorized to Pick-Up?
Transportation Home
Does your child qualify for free and reduced lunch?
Ethnicity Information (please check the ethnic group the child most identifies with)
Required
Primary Language Spoken at Home
Required
Secondary Language Spoken at Home
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Does your child have an IEP?
Is your child on medication?
Will your child take medication at Power Scholars?
Does your child have any allergies, diet restrictions, or health alerts that we should be aware of?
If yes, please explain the allergy, diet restriction, or health alert.
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Which Power Scholars Enrollment Session do you plan on attending?
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