Pupil Pod Intake Form
Please provide your information so we can best match you and your student(s) with the best possible educator!
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Parent Contact Name *
Phone Number *
Email Address *
Primary SCHOOL DISTRICT and SCHOOL NAME *
Is your pod fully formed or would you like to join an existing pod?
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Where would you like to have your pod hosted?
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Student 1: Name and GRADE ENTERING
Student 2: Name and GRADE ENTERING
Student 3: Name and GRADE ENTERING
Student 4: Name and GRADE ENTERING
Student 5: Name and GRADE ENTERING
Student 6: Name and GRADE ENTERING
Pod Hours and Days Desired
STATE OF RESIDENCE
NEW-CAMPS! By PUPIL POD! Please list number of pod members and ages as well as themes desired. Camps are WEEKLY from June 14-August 27th
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