BLVD Harambee-Vanguard Summer Discovery Student Enrollment Form
231 E Grand Blvd, Detroit, MI 48207
Please submit one form for each child you are enrolling in our summer program.
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Email *
Student Last Name *
Student First Name *
Parent or Guardian Phone Number
Please enter a 10-digit phone number in this format 000-000-0000
 *
Child's Birthdate *
MM
/
DD
/
YYYY
Referred by *
Please share the zip code where your child lives most of the time *
Worksite Preference *
What grade level will your child be entering this upcoming school year (2026-27)?
 *
School attended for 2025-2026 school year (this past school year)
If multiple, please write the school where they ended this past school year. Summer Program students MUST attend school in Wayne, Macomb, or Oakland counties.
 *
Please share the ZIP code of the school your child attends. If multiple, please write the ZIP code where they ended the year. *
What is your child's racial and/or ethnic identity? *
What is your child's gender?
 *
Does your child have a special education plan, individual education plan (IEP), or 504 plan as a part of their school’s education? *
Is your child an English learner or English as a second language student? *
At school, is your family eligible to receive free lunch?
 *
Did your child attend a Summer Discovery program last year (2025)?
 *
List any dietary restrictions that your child may have. *
List any allergies that your child may have. *
Will your child need transportation to and from the site? *
List any medical conditions and/or medications that your child may have. *
Provide Emergency Contact Name, Phone Number and Relationship to the Student *
Please rate your child’s enrichment interest from 1-8 *
Etiquette
Youth and Community Development
Hospitality and Customer Service
Entrepreneurship
Mental Health and Wellness
College Prep
Financial Literacy
Climate Resiliency & Energy-Efficient Living
1
2
3
4
5
6
7
8
Students who register for Summer Discovery programming must commit to attending programming throughout the summer. Summer Discovery is not a drop-in program, and it’s important for students to attend daily to receive the full benefits of the program. Will your student be able to attend at least 80% of the summer program days?
Our program is 25 days, so this would mean attending 20 days.
 *
Please note: Along with assessments, your child will be asked to complete a post-survey after the program so that we can evaluate any program-related successes and challenges this year in order to continue to improve Summer Discovery to best serve all students and families. No further action is required to provide consent for your child to participate. If you would prefer that your child not participate, please notify summerdiscoveryconsidine@gmail.com, confirming you would like to opt-out of student surveys.

By submitting this enrollment application, I, the parent/guardian, consent to be contacted by Summer Discovery administration and/or service providers.  
By submitting this form, I give permission for my child to be photographed or recorded during  Summer Discovery activities. I understand that these images or videos may be used for program communications, promotional materials, and social media. My child’s name will not be shared without additional consent.  
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