Summer Learning Program 2026

Thank you for your interest in the Summer Learning program at the University of Portland! Please complete the information below. If you are registering more than one child, please complete all the information requested and select "Register Another Child" at the bottom of this page.

Parent/Guardian Information

First Name

Last Name

Email Address

Contact Phone Number

Relationship to Child

Are you registering more than one child?

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Please read the Discipline Policy and acknowledge your agreement with the terms and conditions, in place of your signature, please type your full legal name below. In an effort to provide every child in the Summer Learning Program an enriching, healthy, and safe learning environment, the University of Portland School of Education reserves the right to dismiss a student if s/he displays distracting, disrespectful, or unsafe behavior such as (but not limited to); disrupting classroom activities, refusing to participate in activities or cooperate with staff, leaving the classroom or campus without permission, using profane or obscene language and teasing or bullying fellow students. *Please note that registration fees are non-refundable if a child is sent home for disciplinary reasons.

Full Name of Parent/Legal Guardian

DATE
February 11, 2026

Emergency Contact

If the parent/legal guardian cannot be reached, who may make local emergency decisions regarding your child(ren)? Please provide two emergency contacts.

Emergency Contact #1

Full Name

Relationship

Phone Number

Emergency Contact #2

Full Name

Relationship

Phone Number

Do all the children you are registering have the same medical provider?

Yes

No

Medical Provider Contact Information

Please provide the contact information for a medical provider.

Provider Contact Information

Name

Phone Number

Hospital

If neither the parent/legal guardian nor named physician can be reached, do you authorize and direct the university officials to send your child to a doctor and or hospital for medical treatment?

Yes

No

Please provide medical provider contact information below when registering each child.

Daily Release Plans

Do all the children you are registering have the same daily release plan?

Yes

No

Please provide daily release information below when registering each child.

Pick-Up Authorization

Besides myself, the parent/legal guardian, I authorize the following people listed below the authorization to pick up my child(ren) from the Summer Learning Program.

Authorized Person #1

Name

Relationship

Phone Number

Authorized Person #2

Name

Relationship

Phone Number

Program Scholarship Opportunity

Limited partial scholarships are available to families who require financial assistance for registration fees.

If you select "yes", please provide a short explanation for your request. A discounted registration fee of $50 per child will be charged prior to submitting registration. If approved, the remaining registration fee will be waived. Please select "no" if you do not wish to be considered for a program scholarship.

Do you wish to apply for a scholarship (applicable to all children registered).

Yes

No

Please provide a short explanation for your request.

Program Registration

Provide each child's information below. To register another child, please click "Register Another Child" at the bottom of the page.

Delete_ID_
Add Child Information Below
Child Information Child's First Name Child's Middle Initial Child's Last Name Child's Birthdate Child's Birthdate Child's Race (mark all that apply) Child's Race (mark all that apply) American Indian or Alaska Native Asian Black or African American Decline Native Hawaiian or Other Pacific White Hispanic Hispanic Yes No Child's Gender Child's Adult Shirt Size Medical Information Please provide the contact information for a medical provider. Provider Contact Information Name Phone Number Hospital If neither the parent/legal guardian nor named physician can be reached, do you authorize and direct the university officials to send your child to a doctor and or hospital for medical treatment? If neither the parent/legal guardian nor named physician can be reached, do you authorize and direct the university officials to send your child to a doctor and or hospital for medical treatment? Yes No Medical Conditions Please select any current or ongoing medical conditions for your child. If a medical condition is not listed, please select "other" and list the medical condition. Select "not applicable" if your child does not have any medical conditions. Serious Allergy Asthma Heart Disease Diabetes Seizure Disorder Other Not Applicable If "Other", please list. Current School Information and Release of Information Please provide current school enrollment information. Teacher Name Grade (Starting next fall) School Name School Address School Address Country Street City Region Postal Code I authorize that information about my child can be given to and/or shared with the University of Portland faculty and MAT students by my child's teacher/school. I authorize that information about my child can be given to and/or shared with the University of Portland faculty and MAT students by my child's teacher/school. Yes No I request that a copy of my child's Summer Learning Program progress record be forwarded to my child's school. I request that a copy of my child's Summer Learning Program progress record be forwarded to my child's school. Yes No I consent to my child's photograph/video being taken on behalf of the University of Portland. Through this release, I grant the University permission to use or publish, in any medium, my child's photograph/video, likeness, or image for any purpose chosen by the University of Portland. I also grant my authorization for the University of Portland, in its sole discretion, to grant third parties' permission to use or publish my child's photograph/video, image, or likeness in any form or medium. I consent to my child's photograph/video being taken on behalf of the University of Portland. Through this release, I grant the University permission to use or publish, in any medium, my child's photograph/video, likeness, or image for any purpose chosen by the University of Portland. I also grant my authorization for the University of Portland, in its sole discretion, to grant third parties' permission to use or publish my child's photograph/video, image, or likeness in any form or medium. Yes No Child Daily Release Plans Please select what daily release options apply to your child. I, the parent/guardian, will pick up my child at 11:30AM everyday My child will walk home My child will bike home My child will take the bus home Family/Friend will pick up at 11:30AM (fill out info below) Other Pick-Up Authorization Besides myself, the parent/legal guardian, I authorize the following people listed below to pick up my child(ren) from the Summer Learning Program. Authorized Person #1 Name Relationship Phone Number Authorized Person #2 Name Phone Number Relationship Summer Learning Program Goals Please rank the subject areas your child needs the most assistance (1 - high through 3 - low). Math Reading Writing/Spelling What do you hope your child will accomplish by the end of the summer learning program? Register another child by clicking the "Register Another Child" link below. When you have completed this registration form, please pay the required registration fees and click "Submit".

Register Another Child

Registration Fee

Total Amount Due

Amount Due
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Amount Due

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Summer Learning Program 2026

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