Smart Cookies Summer Literacy &

Movement Program

Registration Form

Program Dates: July 6, 2026 – August 14, 2026

Program Options: Virtual Jar or In-Person Literacy Lab

Contact: [email protected]

Child Information

First Name *

Last Name *

Child's Age *

Grade Entering *

Pre-K/Entering Kindergarten

Kindergarten/Entering First Grade

Date of birth *

Parent/Guardian Information

Parent/Guardian Full Name *

Phone *

Email *

Emergency Contact Name *

Emergency Contact Phone *

Program Selection

Please Select One-Virtual Jar:

Pre-K Batch 4:00pm-4:30pm

Kindergarten Batch 5:00pm-5:30pm

Please Select One-In-Person Literacy Lab

9:00am

10:00am

11:00am

Learning Information

Does your child have any learning needs, allergies, medical concerns, or accommodations weshould know about? *

What would you like your child to gain from this program? *

Parent Agreement

By checking this box, I consent to receive non-marketing text messages from Smart Cookie Academy. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box I agree to the terms and conditions. Once you submit the form, you will be directed to the PAYMENT page. I understand that registration reserves my child’s space in the Smart Cookies Summer Literacy & Movement Program. I agree to follow program policies, payment deadlines, attendance expectations, and communication updates.