EmailMe Form - One on One Learning Academy

Student Name *
First Last
Today's Date *
Student Age *
School Name *
Grade Entering *
T-Shirt Size *

(Choose One)
Please select all the skills you would like your child to focus on this summer
LetterRecognition
Letter Sounds
Numbers
Reading
Fluency
Reading
Comprehension
Reading Skills
Addition
Subtraction
Multiplication
Division
Fractions
Decimals
Study Skills
FSA Strategies
Additional Information
Sessions (Check all that apply) *
June 12- June 16
June 19 - June 23
June 26- June 30
July 3- July 7
July 10- July 14
July 17- July 21
July 24- July 28
July 31- Aug 4
Aug 7-Aug 11
Aug 14-Aug 18
Are you interested in enrolling your child in Spanish classes? *
Yes
No
Parent Contact Information
Parent Name *
First Last
Phone *
### - ### - ####
Alternate Phone Number
### - ### - ####
Email *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
How did you hear about us? *
Does your child have a sibling that attends our summer camp? If yes, please provide name.
Can One on One Learning contact you via text message? *
Yes
No

(Choose One)