Berwick Academy - Summer Programs Form

Please provide the details below, and we'll ensure your inquiry is directed to the right team or individual.

1. Contact Information

• First Name *
• Last Name *
• Email *
• Phone Number
• City
• State
  - Select a State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Islands

2. Child's Information

• Child's First Name
• Child's Last Name
• Child's Current Grade
  -- Select an Option -- Pre-Kindergarten 3 Pre-Kindergarten 4 Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Post-Graduate Daycare Not in School
• Name(s) and current grade(s) of additional child(ren):
• Are they enrolled at Berwick Academy?
  Please select one. Yes No No, but interested

3. Detailed Inquiry

• Please describe your inquiry or request. *

4. Newsletter Sign Up

• Would you like to receive our summer program newsletter?
  Please select one. Yes No No, but interested

5. Submit

By submitting this form, I consent to Berwick Academy processing my personal data in accordance with their privacy policy.

• *
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