SMART START SUMMER PROGRAM REGISTRATION FORM

SMART START SUMMER PROGRAM REGISTRATION FORM

Mon Amie's Learning Lab
Thank you for your interest in the Smart Start Summer Program. This program is designed to help students close foundational gaps, strengthen ELA and Math skills, and start the next school year confident and prepared. Please complete all sections below to reserve your child's spot. Enrollment is limited to 6 students per session.
Parent/Guardian Information

Please provide your contact information so we can follow up with next steps
Parent Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Information

Please provide information about the student you are enrolling. If registering more than one child, you will complete this section for each student.
Student Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Student's Current Grade Level
Student's School Name
Parish/School District
Has your child previously participated in tutoring or academic support?
Session Selection

Select your child's grade-level session and preferred time slot. Each session is limited to 6 students. Once a session fills, it is closed.
Grade Band
Preferred Time Slot
Student Learning Snapshot

This helps us understand your child's academic needs so we can provide meaningful support.
How confident is your child in their academic abilities?
What best describes your child's learning habits?
How many hours per day does your child typically spend on screens during the summer?
Academic Support Needs

Please tell us more about the specific areas where your child may need support.
Which areas does your child need the most support in?
Has your child struggled academically this school year?
If yes, please describe.
Does your child have any diagnosed learning differences or academic support plans?
Program Goals

Help us understand what you hope your child gains from this program.
What are you hoping your child gains from Smart Start?
What is the biggest academic challenge your child faces?
Future Support Interest

Resources to help your family beyond the summer.
We want to make sure your family has access to the right resources beyond the summer.
Would you like information about continued academic support after Smart Start?
Would you like to receive parenting resources from Mon Amie's related to:
Emergency Contact & Health

Required for all enrolled students.
Required for all enrolled students.
Emergency Contact Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student
Does your child have any allergies or medical conditions we should be aware of?
If yes, please explain:
Payment & Agreement

Please review the payment structure and confirm your agreement before submitting.
Smart Start is a cash-pay program only. Steve Carter tutoring vouchers are not accepted for summer sessions. Your payment schedule: $120 non-refundable deposit due at registration $300 due June 1, 2026 $300 due July 1, 2026 Total: $720 per student
I understand this program is cash-pay only and vouchers will not be accepted
I understand the $120 deposit is non-refundable
Deposit Payment
prevnext( X )
Deposit Payment
Registration deposit

$120.00

Total

$0.00
I confirm all information provided is accurate and complete
Parent/Guardian Signature (Type Full Name)
Date

MonthDayYear
Date
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

SMART START SUMMER PROGRAM REGISTRATION FORM

Parent/Guardian Information

Student Information

Session Selection

Student Learning Snapshot

Academic Support Needs

Program Goals

Future Support Interest

Emergency Contact & Health

Payment & Agreement

Deposit Payment*

Payment Methods

Deposit Payment