*1.Parent / Guardian Information(Required.)

Parent / Guardian First Name

Parent / Guardian Last Name

Parent / Guardian Phone Number

Parent / Guardian Email Address

Parent / Guardian Street Address

Parent / Guardian Zip Code

Please share the zip code where your child lives most of the time.*

Emergency Contact Name, Email and Phone Number?

*2.By submitting this enrollment application, I, the parent/guardian, consent to be contacted by I Can Education and Enrichment Center, Inc. and the Summer Discovery administration and/or service providers. Please initial here.(Required.)

*3.Child's Name and Age(Required.)

First Name

Last Name

Age

*4.Multiple Choice: What grade level will your child be entering this upcoming school year (2026-27)?(Required.)

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

*5.Open Response: Which school did your child attend this past school year? If multiple, please write the school where they ended the year. (Required.)

*6.Open Response: Please share the ZIP code of the school your child attends. If multiple, please write the ZIP code where they ended the year.(Required.)

*7.Multiple Choice: What is your child’s racial and/or ethnic identity?(Required.)

American Indian, Indigenous, Native American, or Alaskan Native

Black or African-American

Asian or Asian-American

Hispanic or Latinx and any race

White or Caucasian

Native Hawaiian or Pacific Islander

Multiracial

Prefer not to answer

Not Listed Above (please specify)

*8.Multiple Choice: What is your child’s gender?(Required.)

Male

Female

Non-binary

Prefer not to answer

*9.Multiple Choice: Does your child have a special education plan, individual education plan (IEP), or 504 plan as a part of their school’s education?(Required.)

Yes

No

Not sure

Prefer not to answer

*10.Multiple Choice: Is your child an English learner or English as a second language student?(Required.)

Yes

No

Not sure

Prefer not to answer

*11.Multiple Choice: At school, is your family eligible to receive free lunch?(Required.)

Yes

No

Not sure

*12.Multiple Choice: Did your child attend a Summer Discovery program last year (2025)?(Required.)

Yes

No

Not sure

*13.Students who register for Summer Discovery programming must commit to attending programming throughout the summer. Summer Discovery is not a drop-in program, and it’s important for students to attend daily to receive the full benefits of the program. Will your student be able to attend at least 70% of the summer program days? For example, our program is 27 days, a student would be expected to attend 19 or more of those days (70% attendance).(Required.)

Yes

No

*14.Parents/Guardians and participating children are Required to Attend one Parent/Guardian and Child Orientation. Please choose your orientation date.(Required.)

Thursday, April 23, 2026 6-7pm

Tuesday, May 7, 2026 6-7pm

Saturday, May 16, 2026 11:30am-12:30pm

Send me a copy of my responses via email