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Green Ivy Summer 2024 Registration
We're thrilled at the opportunity to work with your child(ren) this summer! Please fill out this form and we will be in touch with potential options.
Please feel free to email info@greenivyed.com with any questions.
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1.
Student(s) Name(s) (Last, First)
(Required.)
*
2.
Parent Name (Last, First)
(Required.)
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3.
Phone Number
(Required.)
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4.
Email Address
(Required.)
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5.
Name of School and (Upcoming) Grade Level
(Required.)
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6.
What areas would you like us to focus on? (check all that apply)
(Required.)
Writing
Executive Functioning Skills
Subject/Content Support (please specify)
College Application Process
College Transition Program (for students in college)
Any additional info
*
7.
What areas would you like us to focus on? (check all that apply)
(Required.)
Writing
Executive Functioning Skills
Subject/Content Support (please specify)
College Application Process
College Transition Program (for students in college)
Any additional info
8.
What weeks are you interested in?
June 3
June 10
June 17
June 26
July 8
July 15
July 22
July 29
August 5
August 12
Any specific time/day preferences? We are in the office M-Th and work virtually Friday
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9.
Desired Number of Time Slots Per Week
(Required.)
*
10.
Are you hoping for in-person or virtual instruction?
(Required.)
In-person only
Virtual only
Depends/Other - please explain
11.
Feel free to add anything else that could be helpful.