Imagination Rocket: 2018 Summer Enrollment Application

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Welcome! Please complete all pages of this form to enroll your student in our 2018 summer program.

Note that the application deadline (Friday, June 29) has passed. We will be considering new enrollment applications on a case-by-case basis. If you have any questions, please contact us at hello@imaginationrocket.org.

Student's First Name *

Student's Last Name *

Student's Date of Birth *

YYYY

Student's Email

You can leave this blank if Student does not have their own email address.

Grade Student is entering this fall *

Student's Interests *

Please describe below any interests, hobbies, or favorite subjects your Student has. Do they have any dreams or aspirations about what they might do once they reach adulthood?

Where did you hear about Imagination Rocket? *

At a table in the New Life lobby

In the New Life bulletin

In a New Life email newsletter

From a friend

From Boosters Club

Other:

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