Fill out application below:

Name Of student

First Name

Last Name

Age of student

School

Grade

What Draws You To The Summer Program?

Your talents. Are you a singer? If so, do you know your voice type? Are you an amateur astronomer? Do you like drama? Let us know what interests you!

What Do You Hope To get Out of This Program?

Parent Section

Name Of parent or Guardian

Address

Phone

(###)

###

####

Home Number

(###)

###

####

PLEASE INDICATE PRE-EXISTING MEDICAL CONDITIONS:

YOUR CHILD’S PRIMARY CARE DOCTOR & PHONE #:

Emergency Contact

Contact Name

First Name

Last Name

Relationship

Address

Telephone

(###)

###

####

To submit your tuition payment online, Click here

Or to pay at a later date or inquire about scholarship opportunites you can call 203.441.7488