Summer Accelerate - Lee's Learning Loft
Registration opens April 26th and closes May 21, 2021
Email *
Student First and Last Name *
Grade Student is Entering *
Student's Date of Birth *
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Student enrollment type for the 2021-2022 school year *
Which school will the student be attending for the 2021-2022 school year? *
Student District ID# *
Parent #1 First and Last Name *
Parent #1 Phone# *
Parent #1 Email *
Parent #2 First and Last Name
Parent #2 Phone#
Parent #2 Email
Gender *
Does your child have an IEP for Special Education Services? *
Does your child have an EP for Gifted Services? *
Home address *
Emergency Contact Full Name and Phone Number *
Child's Primary Doctor's Name and Phone Number *
Preferred Hospital Choice *
Known allergies *
Dietary Restrictions *
Any medical concerns *
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