Summer Learning 2023 Registration

Session Option *

6 Week Full Day 8:15 am - 2:45 pm

6 Week Half Day 8:15 - 11:30 am

3 Week Session A Full Day 8:15 am - 2:45 pm

3 Week Session A Half Day 8:15 - 11:30 am

3 Week Session B Full Day 8:15 am - 2:45 pm

3 Week Session B Half Day 8:15 - 11:30 am

Child's Name *

Gender *

Male

Female

Non-Binary

Age *

Current School *

Date of Birth *

Month

Day

Year

Grade completed in June 2023 *

How did you hear about CBA's Summer Enrichment Program? *

If other, please specify:

Parent/Guardian Name *

Address *

City *

State *

Zip *

Mobile Phone *

Email Address *

Emergency Contact Person's Name *

Relationship to Child *

Mobile Phone *

My child could really use help with:

Media Release *

Yes

No

I authorize Chesapeake Bay Academy to use, reproduce, and/or publish photographs and/or video of my enrolled child – including name, likeness and/or voice. I understand that this material may be used in various publications, recruitment materials, or for other related endeavors. This material may also appear on the Chesapeake Bay Academy website and or social media channels. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, Chesapeake Bay Academy may publish materials, use my name, photograph, and/or make reference to me in any manner that Chesapeake Bay Academy deems appropriate in order to promote/publicize marketing and communication opportunities.

Empowering children who learn differently for over 30 years.

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Summer Learning 2023 Registration