LIT Academy Summer Bridge Program Registration (Incoming 9th Graders)
Please complete this form for registration into the LIT Academy Summer Bridge Program. All sections must be filled out completely.
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Program Overview

THIS IS NOT SUMMER SCHOOL.

LIT Academy Summer Bridge is a dynamic youth leadership, wellness, and transition program designed to help incoming freshmen prepare for high school through:

  • Leadership development
  • Behavioral health & self-care education
  • Team-building activities
  • Creative and community activations
  • Career & pathway exposure
  • Positive mentorship
  • Fun off-site experiences

This program is designed to support students socially, emotionally, and academically as they transition into high school.

Program Dates

June 2, 2026 – June 30, 2026
(Tuesdays, Wednesdays & Thursdays)

Program Cost & Commitment Policy

The total program commitment fee is $75 per youth.

Families will receive $50 back when the student successfully attends 10 out of the 12 program sessions.

This commitment fee helps ensure students remain engaged and committed to the full program experience.

Transportation

Transportation may be available from select APS feeder schools depending on need and availability. Transportation requests must be indicated on this registration form.

Important

Students may participate in:

  • On-site activities
  • Community outings
  • Behavioral health & leadership workshops
  • Physical activities
  • Team-building experiences

Completion of this form does not guarantee placement until payment & confirmation is received.

SECTION 1: Student Information
Student Full Name
 *
Student Date of Birth *
MM
/
DD
/
YYYY
Student Age *
Current Grade Level *
Current School Attending *
Student Gender
 *
Home Address *
City/ Zip *
SECTION 2: Parent/Guardian Information
Parent/Guardian Full Name *
Relationship to Student *
Parent/Guardian Phone Number
 *
Parent/Guardian Email Address
 *
Preferred Method of Contact *
SECTION 3: Emergency Contact Information
Emergency Contact Full Name *
Emergency Contact Relationship to Student *
Emergency Contact Phone Number *
SECTION 4: Medical & Wellness Information
Does the student have any known allergies? *
If yes, please explain allergies or dietary restrictions.
Does the student have any medical conditions we should be aware of? 
 *
If you answered 'Yes' above, please explain the condition(s) or accommodation needs in detail.
Does the student require any accommodations, supports, or have any physical limitations?
 *
If you answered 'Yes' above, please explain the condition(s) or accommodation needs in detail.

INSURANCE INFORMATION (Optional)

Insurance Provider

Policy Number
SECTION 5: Transportation Needs
Does your student require transportation assistance? 
 *
If yes, which school pickup location would your student most likely use?
Clear selection
Parent/Guardian Transportation Acknowledgement
 *
Required

SECTION 6: Program Expectations & Commitment

LIT Academy is built on leadership, accountability, respect, and participation.

Students are expected to:

  • Show respect to staff, mentors, and peers
  • Participate positively in activities and discussions
  • Follow all safety guidelines and behavioral expectations
  • Attend consistently and communicate absences
  • Represent themselves and their schools positively

Repeated unsafe or disruptive behavior may result in removal from program activities.

Program Expectations Agreement


 *
Required

SECTION 7: Program Commitment Fee Acknowledgement

The Summer Bridge / LIT Academy Program requires a $75 commitment fee per student.

Students who attend 10 out of the 12 program sessions will receive $50 back at the completion of the program.

This policy is intended to encourage commitment, consistency, and full participation in the experience.

Commitment Fee Acknowledgement 
 *
Required

SECTION 8: Photo/Video Consent

Photos and videos may be taken during program activities for:

  • Social media
  • Program promotion
  • Community updates
  • Reports & presentations

Student names will not be publicly shared without additional permission.

Do you give permission for your student to be photographed or recorded?
 *

SECTION 9: Liability Waiver and Release

I understand that participation in program activities may involve physical activity, transportation, community outings, and off-site experiences.

I acknowledge that participation includes some risk of injury.

I agree to release and hold harmless:

  • LIT Academy
  • APS partners
  • Unfeigned International
  • Program staff
  • Volunteers
  • Community partners

from liability related to participation except in cases of negligence.

I certify my student is physically able to participate.

Liability Waiver Agreement
 *
Required

SECTION 10: Digital Signature

Parent/Guardian Full Name

Typing your full name below serves as your digital signature and confirms:

The information provided is accurate.

You authorize your student’s participation.

You agree to all program terms and expectations.

 *
Submit
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