Name First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Child's Name First Name Last Name Child's Age * Child's Pronouns How did you hear about us? What has your child’s education consisted of up to this point? * How would you rate your understanding of Self-Directed Education on a scale of 1 to 5, where 1 is no understanding and 5 is a deep understanding. 1 2 3 4 5 What makes you feel that Macomber Center for self-directed learning might be a good fit for your child? * If you are interested in full-time membership you can leave this field empty. If you are interested in part-time membership, please indicate your preferred number of days. Part-time options are 2, 3 or 4 days a week. Number and ages of siblings? Will your child be enrolled in any other programs, follow any curriculums, or be expected to fulfill any academic requirements while they are members of Macomber? If so, please indicate the sorts of things they will be doing. Is there any additional information you would like us to know about your child? Thank you!
