2022 Middle School Summer Learning Registration Form

Middle School Summer Learning Registration

Middle School Students (Grades 6-8)
Student Information
Currently, only Eton Academy students can enroll for the summer programs. For more information about applying to Eton, go to the following website: https://www.etonacademy.org/admissions/applying-to-eton. Is your student currently enrolled at Eton Academy? *

Yes No
Entering grade for 2022 school year *
Current Age of your Student? *
Full Name *

First Name Last Name
Child prefers to be called *
Student Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Student's Date of Birth

Month Day Year
Your student will be living with:

Parent Stepparent Grandparent Relative Guardian
Parental Information
Guardian 1 - Full Name *

First Name Last Name
Address (only with different from student)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
example@example.com
Relationship *
Guardian 2 - Full Name

First Name Last Name
Address (only with different from student)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
E-mail
example@example.com
Select Primary Contact
Additional Information
Does your student have any health, allergy, or medical conditions that we should be aware of when they attend the Summer Learning Program? If so, please explain: *
Does your student take any medication that we need to be aware of when they attend the Summer Learning Program. Please describe below. PLEASE NOTE: We ask that families dispense all required mediations to their student in the morning or afternoon prior to attending the Summer Learning Program. *
What are your goals for your student during the summer months? *
What do you hope your student experiences during the Summer Learning Program?
Please share any additional information that you believe would be helpful for your student’s Summer Learning Teachers to know.
Please describe your student’s most recent progress at Eton.
My student is most frustrated when...
Describe areas of strength that you or your student have identified.
Describe your concerns about your student that are important for our teachers to be aware of regarding social and/or self-concept issues if any.
Eton Summer Program Statement of Agreement
Statement of Understanding
I understand and agree to follow the philosophies articulated in the Eton Student-Parent handbook.
I agree *
Summer Course Scheduling
Review the course descriptions and select the preferred courses you are signing up for.

*Aftercare will not be available this summer. Students will need to be picked up no later than 3:45.

*Upon registration, an email communication will be sent home with more information about your student’s summer learning program.
Morning Academic Program
Four Week Morning Academic Program: Reading/Writing, Math & Tech for Learning.

July 5th - July 28th, Monday - Thursday 8:30 AM -11:45 AM.
Afternoon Enrichment Programs
One Week Afternoon Enrichment Program: STEAM & Essentials

July 5th - July 7th, (Short week) Tuesday - Thursday, 12:30 PM - 3:30 PM
One Week Afternoon Enrichment Program: Art

July 11th - July 14th, Monday - Thursday, 12:30 PM - 3:30 PM.
One Week Afternoon Enrichment Program: Athletics

July 18th - July 21th, Monday - Thursday, 12:30 PM - 3:30 PM.
One Week Afternoon Enrichment Program: Music/Drama

July 25th - July 28th, Monday - Thursday, 12:30 PM - 3:30 PM.
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Middle School Summer Learning Registration

Student Information

Parental Information

Additional Information

Eton Summer Program Statement of Agreement

Summer Course Scheduling

Morning Academic Program

Afternoon Enrichment Programs