The Academy at Charlemont

An independent, coeducational day school for grades 6 through postgraduate

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2021 Summer Program Registration

Please complete the following form to register for The Academy summer programs. We will be in touch more as the spring unfolds and you should expect to be be contacted for payment by June 1. Lunch will not be provided.

Person completing this form*
Student Information
Name of Participant*
First Last
Pronouns*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Student Email
Gender*
- Male
- Female
- Self Identify
Current School*
Current Grade*
Age*
Family Contact Information
Parent/Guardian 1 Name*
First Last
Parent/Guardian 1 Pronouns*
Parent/Guardian 1 Relationship to Student*
Parent/Guardian 1 Same Address as Student?*
- Yes
- No
Parent/Guardian 1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian 1 Phone Same as Student?*
- Yes
- No
Parent/Guardian 1 Phone*
Parent/Guardian 1 Cell Phone*
Parent/Guardian 1 Email*
Does the student have another parent or guardian?*
- Yes
- No
Parent/Guardian 2
Parent/Guardian 2 Name
First Last
Parent/Guardian 2 Pronouns
Parent/Guardian 2 Relationship to Student
Parent/Guardian 2 Address Same as Student?*
- Yes
- No
Parent/Guardian 2 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian 2 Phone Same as Student?
- Yes
- No
Parent/Guardian 2 Phone*
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Email
How did you hear about The Academy?*
Program Details
I am interested in carpooling.*
My child will participate during the following weeks:*
Week 1 Mornings (8:30-11:45am): During the week of July 26 to July 30, my child would like to participate in:*
Week 1 Afternoons (12:15-3:30pm): During the week of July 26 to 30, my child would like to participate in:*
Week 2 Mornings (8:30-11:45am): During the week of August 2 to 6, my child would like to participate in:*
Week 2 Afternoons (12:15-3:30pm): During the week of August 2-6, my child would like to participate in:*
Phone
This field is for validation purposes and should be left unchanged.