EM Academy Enrichment Sign-up

Thank you for your interest in our EM Academy Enrichment Programs! Please complete the form below and we’ll get back to you shortly to confirm receipt.

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Parent Name (First/Last)*

First Last

Second Parent Name (First/Last)*

First Last

Parent Email*

Second Parent Email*

Parent Phone*

Second Parent Phone*

Would you like to add another Parent?*

Yes

Current City

Current State

Student Name (First/Last)*

First Last

Student Grade*

Current School*

Select EM Location*

Online

Newton, MA (for elementary students, as available)

Would you like to add another student?*

Yes

Student Name (First/Last)*

First Last

Student Grade*

Current School*

Select EM Location*

Online

Newton, MA (for elementary students, as available)

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How did you first learn about Engaging Minds?*

Referrer Name

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