Registration for Cage-Free Learning School's Off Day Camps Fall 2019 Survey

This form is for students who have already submitted their background information to Cage-Free Learning. If you have not, do that first here.

This registration is for Puzzles and Logic camps on Mondays September 16, October 14, and November 11, 2019. Campers may attend for a half- or full-day. Hours are 9AM-4:30PM, with extended hours available (see below).

Campers: ages 8-14; Counselors-in-training (CITs): ages 12 and up.

Price:
- Half-day (9am-12pm OR 1:30-4:30pm): $70 for campers, $40 for CITs
- Full-day (9am-4:30pm): $140 for campers, $80 for CITs
(alternate pricing available *)
Extended hours: 8 A.M. – 9 A.M and 4:30 P.M. – 5:30 P.M. $20/hour for one camper, $15/hour/camper if multiple campers.

Note that this camp is held at my house in Louisville, which is also home to two furry dogs. While the dogs will not be allowed where the class is held (even when class is not in session), and will not come in contact with the students, I cannot eliminate the possibility of an allergic reaction.

For more information about this camp, please see my website.

1.I have previously submitted background information for this student to Cage-Free Learning. If you haven't, you should fill that out first by clicking here.(Required.)

Yes

2.Contact Information (your name and email are required; other fields are only required if they've changed since you last gave me information):(Required.)

Your First Name

Your Last Name

City

State

Email Address

Phone Number

3.Student information. If you wish to enroll multiple students, please fill out a separate application for each one.(Required.)

First name:

Last name:

Age:

Birth date:

Preferred pronoun:

Email (optional):

Current school(s):

Current grade(s):

4.If this student is aged 12 or older, are they willing to work with younger campers at times as needed?

Yes, they will be a CIT, and pay the reduced rate

No, they will be a camper

Comments:

5.For which days will this camper attend?(Required.)

Monday, September 16

Monday, October 14

Monday, November 11

Comments:

6.This camper will attend:(Required.)

Mornings

Afternoons

Comments:

7.Extended hours are available before (8AM - 10AM) and after (4:30PM - 5:30PM) camp for $20/hour per student. Will you want any extended hours?(Required.)

No.

Yes. Indicate which times this student will attend:

8.Request for alternate pricing.

All students who would benefit from these classes ought to be able to participate at least once. After that, parents, students, and I can better determine how important these classes are to the student. However, there may be limited slots for alternate price students. These slots will be allotted based on the payment reduction needed AND the emotional need of the student.

If you will need an alternate price for this student to attend, how much can you pay ($ and/or time and tasks)?

If you need an alternate price AND have not previously received one:
Please describe this student's emotional / intellectual need for this class.

9.Comments and questions

If you haven't already filled out a Learner Profile for this student, please do so now at https://www.surveymonkey.com/r/learnprofile. This lets me individualize camp activities for this student.