Square Root Academy: Scholar Registration
Thank you for your interest in embarking on a fun learning experience with Square Root Academy!

This series takes place on Tuesday's & Thursdays from 3pm-4:30pm and is for 5th & 6th graders.

For any questions or general inquiries, feel free to contact us at admin@squarerootacademy.com and we hope to see your scholar soon!

As always stay curious!
Email address *
Enter Parent/Guardian first name *
Enter Parent/Guardian last name *
Enter Parent/Guardian Phone Number (ex. 123-456-7890) *
Enter Parent/Guardian email *
Enter Household Address (include street address, unit number if it applies, city, state, and zip code) *
Enter Scholar Contact Number (ex. 123-456-7890) *
Enter Scholar Email *
Enter Scholar First Name *
Enter Scholar Last Name *
What is the gender of your scholar? *
Ethnic background of scholar *
Enter Scholar Birthday (use format MM/Day/Year (i.e. 02/8/1998) *
MM
/
DD
/
YYYY
Grade of your scholar (Square Root Academy serves scholars in grades 5th-12th) *
Enter school scholar is currently enrolled in *
School district attended by your scholar? *
How long have you been involved with Square Root Academy? *
How many programs have you done with Square Root Academy? *
How did you hear about us/this program/event? *
Does the scholar receive (or is eligible to receive) free or reduced-cost lunch from school? *
Can we contact you about other Square Root Academy Programs? If yes, we'll add you onto our newsletter so you hear about all the fun things we have in store throughout the year. *
Does the scholar have any physical or learning disabilities? If yes, please describe. You may also enter "Decline to state." *
I agree to allow Square Root Academy to collect and use my scholar's information to assess my scholars educational growth. (This information is used to track scholar progress). *
Will your scholar be using a school-provided laptop or computer (i.e. Chromebook, etc.) for this program? *
A copy of your responses will be emailed to the address you provided.
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