Brighton eLearning Student Application
Please fill out this application request. The weekly cost is $200. The hours of e-learning are 8:30AM to 3:30PM. 9 week commitment and first and last due in order to reserve a spot. One application per student. If you are interested in enrolling more than one child, please fill out a separate application for each child. If a question does not apply to you, please input N/A.
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Email *
Student's Name *
First and last name
Parent's Name *
First and last name
Parent's Email *
Parent's Phone Number *
What grade is your student in? *
Required
Does your child have any special needs? *
Does your child have any allergies? *
Have you or your child traveled outside the US in the last 30 days? *
Have you or your child had any COVID-19 symptoms in the last 30 days? *
How did you hear about Brighton Learning?
Is there any additional information you would like the Brighton Learning team to know about your child?
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