Summer Program Student Information Form 

We are excited for your scholar to join our summer program, we would learn more about you and your scholar, so please provide responses to the following questions so that  we have the best experience possible this summer.

Instructions:

  1. Please complete all sections of the form accurately.

  2. Required fields are marked accordingly; be sure to provide information for those.

  3. If you have any questions or special considerations, please note them in the designated areas.

  4. Once finished, click 'Submit' to finalize your responses. By doing so, you acknowledge that your submission serves as your digital signature.

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Which Program Will Your Scholar Participate in? *
Scholars First Name *
Scholars Last Name *
Preferred Name/Nickname 
Date of Birth  *
MM
/
DD
/
YYYY
Has the scholar participated in a summer program before?
Clear selection
Which DC Ward Does the Scholar Live in? *
School Name (Entering Fall 2025) 
Will the scholar require medication be administered during the program?
Clear selection
If yes, please specify. 
Does the scholar require special learning accommodations or language assistance?
Clear selection
If yes, please specify.
Who else is authorized to pick up your scholar? Name
Authorized pick-up person phone number.
How will the scholar travel to and from the program?
Clear selection
If traveling on their own, please specify how? 
Is there other information that you would like to share about your scholar. 
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