Summer Academy 2023 - Program Registration
Complete the form below to register for the Breakthrough Miami Summer Program at Beacon College Prep for Summer 2023.

Program Dates: June 20 – July 28
Times: 8:30 - 4:00
*Before and After care available

Location:  Beacon College Prep, 13400 NW 28th Ave. Opa-Locka, FL 33054

This tuition-free, high-quality six-week summer program is designed to support students’ academic, social and physical development.
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Student's First Name *
Student's Middle Name
Student's Last Name *
Student's Date of Birth *
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DD
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Student's Gender *
Student's School ID Number *
Student's Current School *
Is your child proficient in English? *
Other Language(s) spoken in your home *
Required
Home Address *
City *
Zip Code *
Student's Ethnicity *
Ethnicity - Other, please specify
Student's Race *
Student's Current Grade *
Does the student have health insurance? *
Student's primary caregiver (parent/guardian) - Full Name *
Student's primary caregiver email address *
Student's primary caregiver phone number *
Is this a cell phone number? *
We want to get to know your child better so that we can provide the best possible experience in our programs. Please tell us more about your child…What are the main ways in which your child communicates? (Mark all that apply) *
Required
What, if any, help does your child receive at this time? (Mark all that apply) *
Required
What conditions does your child have that are expected to last for a year or more? (Mark all that apply) *
Required
If you marked “None of the above” on the previous question, please skip the next two questions and sign below. If you marked any other answer on the question above, please answer the remaining questions
Do any of the conditions marked above make it harder for your child to do things that other children of the same age can do?
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To support your child’s successful participation in this program, in what areas might s/he need extra assistance?
Please tell us anything else you think it is important for us to know about your child:
I give my permission for this information to be submitted to The Children's Trust for program quality and evaluation purposes. The Children’s Trust provides funding for the program. *
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