Essentials in Learning Workshop Registration

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Please register each student separately. NOTE: Choose the appropriate workshop/camp from the 1st drop-down menu .
(Click directly on gray text to fill out short answer or see drop-down options)

Email *

Workshop choice *

Student name *

Student's school *

Grade level *

Parent/guardian name *

Parent/guardian phone *

Parent/guardian email *

Optional student information

The following items will help us prepare for your student. We are able to differentiate within the workshop for a variety of student needs.

Basic information

Gifted / ALP

ADHD

Special education / IEP

504

Low grades last year

Okay grades -- but can do better

Social-emotional struggles

Other:

What are your student's struggles?

Not motivated to do homework

Will have a heavy academic load

Transitioning from 8th grade to high school

Preparing for college

Unorganized and forgetful

Problems with testing

Problems with long-term projects

Problems with written assignments

Making and keeping friends

Drama with other kids

Bullying situations

Social awkwardness

Girlfriend/boyfriend/dating issues

Other:

What do you HOPE for your student as a result of this workshop or camp learning experience?

Payment

An invoice will be emailed upon receipt of this registration with a link to pay online via credit card (including a 3.5% processing fee). Or you can mail a check to Essentials in Learning, LLC, 2591 Legacy Way, Grand Junction, CO 81503. Your spot will be reserved upon receipt of payment. Space is limited to 25 students for workshops and 15 for camps.

Method of payment

Check will be mailed to Essentials in Learning / 2591 Legacy Way / GJ, CO 81503

Credit card payment upon emailed receipt of invoice

Other as discussed on the phone with Essentials in Learning

My child was chosen as the scholarship recipient for his/her home school

My child was given the reduced price for his/her home school

Other:

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Publicity and Media Consent

Yes -- I consent to my child being photographed, video/audio taped and/or interviewed by representatives of television, radio and other news or broadcast media organizations if such are authorized in advance by Essentials in Learning and are supervised by EIL staff. I also consent to Essentials in Learning using such photographs or video/audio recordings of my child for official Essentials in Learning communication purposes via print or internet-based media, indluding EIL publications, websites, or EIL social networking websites.

No -- I do not consent to any of the above

Partial Consent -- I do not consent to the above, but may give partial consent at a later date, per conversation with EIL owners and a written agreement which EIL will provide for me to sign..

Other:

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