The Mae C. Johnson Education & Cultural Enrichment Academy 2020 Summer Program
Dates: June 15th - July 24th Time: 10am - 2pm Location: ZOOM Live Meeting Room
Email address *
Clear selection
Student Name (first & last) *
Address *
Phone Number *
Emergency Contact Number (optional)
Race/Ethnicity *
I understand the program hours are Monday-Friday, virtually 10am-2pm *
I grant permission for my child's picture to be used in TVPI marketing material *
My child has access to google meets and/or zoom *
This form serves as written permission for the above-mentioned student to enroll in The Village Project’s summer fun program from June 15th, 2020-July 24th, 2020.
By submitting this form, I declare that I am the legal parent/caregiver for the minor child listed above and authorized to grant such permission.
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