Register your student for one of our Summer Student Success groups! 

Click here to learn more about our groups this summer! 

Parent Name *

First

Last

Parent's Phone Number *

Parent's Email *

Student's Name *

First

Last

Student's date of birth *

Grade in school next year *

Any allergies or special needs? *

Choose the dates and times your student will attend *

• June 8 - 22 Middle School Group (M-W-F @ 10:00 - 11:30 AM)
• June 8 - 22 High School Group (M-W-F @ 1:00 - 2:30 PM)
• July 20 - August 5 Middle School Group (M-W-F @ 10 - 11:30 AM)
• July 20 - August 5 High School Group (M-W-F @ 1:00 - 2:30 PM)

Registration Costs *

• June 8 - 20 Early Registration (by May 7, 2022): $500.00
• June 8-20 Regular Registration (after May 7, 2022): $550.00
• July 20 - August 5 Early Registration (by June 20): $500.00
• July 20 - August 5 Regular Registration (after June 20): $550.00

Payment

• On the date of registration, half of the total registration cost is due. We will contact you to take your payment.
• The balance will be due on the first day the group meets.

By submitting this form... *

• You acknowledge that you have the legal authority to seek and grant permission for professional services for your minor child or teen, there being no legal decree disallowing your authority to assume such responsibility.
• You authorize Monte W. Davenport and Kay Lynn Davenport to contact you at the phone number and email address listed above to finalize your registration and to provide additional information regarding group meetings as needed.

Submit

After you have submitted this form, we will contact you to complete your registration.

(c) 2010-2022, Monte W. Davenport, Ph.D.