Registration 2025-2026 (v2.0)

Create an account to save your information and access our online portal!

Login Name

Password

Retype Password

Parent/ Guardian First Name *

Parent/ Guardian Last Name *

Submit as a company

Email *

*parent email addresses given at registration will be used for all CA email communications

Phone

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Employer

Second Parent/ Guardian First & Last Name

Second Parent Phone #

Second Parent Address (if different from First Parent Address)

Second Parent Employer

Youth #1 Name (first and last)

Youth #1 Gender Identity

Youth #1 DOB (Month/Date/Year)

Youth #1 email address (if applicable)

Which Program are you registering youth #1 for? *

CYP (ages 15 to 18) T/Th

CP4 ( ages older 13 to 15) T/Th

CP3 (ages 11 to 13) T/Th

CP2 (ages 9 through 10) T/Th

CP1 (ages older 7 through 8) T/Th

CC (ages 4 to 8) T/Th

CC (ages 4 to 8) Wed, must be combined with T/Th

Deep Dives (ages 9 to 14) Wed, must be combined with T/Th

Deep Dives (ages 14 to 18) Fri. 9:30-12:00pm must be combined with T/Th

The form auto-fills with their current program. To make a change, uncheck their current program and check the box for the new program(s) you wish to register for.

Please List Youth #1 Allergies

Please list any medications youth #1 takes

Youth #2 Name

Youth #2 Gender Indentity

Youth #2 DOB (Month/Date/Year)

Youth #2 email address (if applicable)

Which Program are you registering youth #2 for?

CYP (ages 15 to 18) T/Th

CP4 ( ages older 13 to 15) T/Th

CP3 (ages 11 to 13) T/Th

CP2 (ages 9 through 10) T/Th

CP1 (ages older 7 through 8) T/Th

CC (ages 4 to 8)

CC (ages 4 to 8) Wed, must be combined with T/Th

Deep Dives (ages 9-14) Wed. must be combined with T/Th

Deep Dives (ages 14-18) Fri., must be combined with T/Th

The form auto-fills with their current program. To make a change, uncheck their current program and check the box for the new program(s) you wish to register for.

Please List Youth #2 Allergies

Please list any medications youth #2 takes

Youth #3 Name

Youth #3 Gender Identity

Youth #3 DOB (Month/Date/Year)

Youth #3 email address (if applicable)

Which Program are you registering youth #3 for?

CYP (ages 15 to18) T/Th

CP4 ( ages older 13 to 15) T/Th

CP3 (ages 11 to 13) T/Th

CP2 (ages 9 through 10) T/Th

CP1 (ages older 7 through 8) T/Th

CC (ages 4 to 8)

CC (ages 4 to 8) Wed, must be combined with T/Th

Deep Dives (ages 9 to 14) Wed, must be combined with T/Th

Deep Dives (ages 14 to 18) Fri 9:30am-12:00pm, must be combined with T/Th

The form auto-fills with their current program. To make a change, uncheck their current program and check the box for the new program(s) you wish to register for.

Please List Youth #3 Allergies

Please list any medications youth #3 takes

Youth #4 Name

Youth #4 Gender Indentity

Youth #4 DOB (Month/Date/Year)

Youth #4 email address (if applicable)

Which Program are you registering youth #4 for?

CYP (ages 15 to18) T/Th

CP4 ( ages older 13 to 15) T/Th

CP3 (ages 11 to 13) T/Th

CP2 (ages 9 through 10) T/Th

CP1 (ages older 7 through 8) T/Th

CC (ages 4 to 8)

CC (ages 4 to 8) Wed, must be combined with T/Th

Deep Dives (ages 9 to 14) Wed., must be combined with T/Th

Deep Dives (ages 14 to 18) Fri 9:30am-12:00pm, must be combined with T/Th

The form auto-fills with their current program. To make a change, uncheck their current program and check the box for the new program(s) you wish to register for.

Please List Youth #4 Allergies

Please list any medications youth #4 takes

School District

Permission is hereby granted to use any recognizable likeness of members of my family, via conventional or digital photography, still or video, for promotional or other suitable purposes in support of Cupola Academy, in return for no monetary consideration. Electronic signatures count as original for all purposes of this agreement. By typing your name as a signature below, you agree to the terms and provisions of this agreement.

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Relationship to Youth

Check off if you would like to donate an additional $5 towards our Annual Giving to help us reach 100% family participation. Having 100% participation helps CA demonstrate to potential large donors that we have an engaged and invested community.

Choose Payment Schedule

Pay full balance upon receipt of registration confirmation.

Pay 10% upon receipt of registration confirmation, & remaining 90% in two equal payments due 6/1/2025 and 11/1/2025

Pay 10% upon receipt of registration confirmation, & remaining 90% in eight equal monthly* payments from May- Dec. 2025. Please note that there is a 5% finance charge for this option to cover additional administrative costs.

Choose your payment method below

Are you interested in Financial Aid?

At Cupola Academy, we view it is our responsibility to cultivate a learning environment that helps youth learn about the complexities of growing up in the 21st century, navigating our changing world with an open and inclusive mindset. We believe youth should be exposed to perspectives and beliefs that stretch them, guided by trusted facilitators who can support their growth and exploration while also respecting individual families’ value sets. We believe that youth have the capability to thoughtfully read texts and engage in respectful dialogue around sensitive topics facing our society today, including racism, gun violence, gender identity, and other complex and nuanced political and social issues. Although not mandated, vaccines are strongly encouraged.

This Enrollment Contract runs from the date of signing (today) through June 6, 2026. I understand that registration is a full-year commitment and that by inputting my initials, I agree to honor the program fee payment amount and schedule. *

Grandparent Household #1 (Please list the first and last name of all members)

Cupola Academy values the involvement of grandparents in our community! We collect grandparent contact information to keep them informed about CA news, invite them to special events, and share volunteer opportunities.

Grandparent mailing address (if applicable)

Grandparent email address (if applicable)

Name(s) of Grandparent(s) if applicable

Grandparent Household #2 email address(es) -- please separate with a comma

Grandparent phone number(s) if applicable