Summer 2022 Workshop Registration
Please fill out the following form for Momentum's summer programs per child
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Email *
Parent Name *
Student Name (One form per child) *
Upcoming Grade *
Special Needs/Allergies/IEP/504
Parent Phone Number (Emergency Contact) *
I consent to my child being photographed during workshop activities. *
Are you currently a client of Momentum Tutoring? *
Please select which Academic program(s) you would like to enroll in:
Kindergarten - 2nd grade
3rd grade - 5th grade
6th grade and up
Which weeks would you like to enroll your child for the Academic programs? (minimum of two required)
Please select which elective class(s) you would like to enroll in:
Which weeks would you like to enroll your child for the Elective classes? (minimum of two required)
Are you new to Momentum Tutoring?
If you are new to Momentum please take a moment, after submitting this form, to fill out the registration form on the Momentum Tutoring website. This will allow us to send invoices for summer.
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