Name *

First Name

Last Name

Phone *

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###

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Child #1 Name

First Name

Last Name

What phase of learning is this child in?

Core Phase Babies (ages 0–5)

Core Phase Kids (ages 5–8)

Love of Learning (ages 9–12)

Beginning Scholar: Shakespeare Conquest + scholar club

Intermediate Scholar: Shakespeare Conquest + Pyramid Project

Advanced Scholar: Quest 3 + Pyramid Project (TERM 1) Shakespeare Conquest + Pyramid Project (TERM 2)

Date of Birth

MM

DD

YYYY

Child #2 Name

First Name

Last Name

What phase of learning is this child in?

Core Phase Babies (0–5)

Core Phase Kids (5–8)

Love of Learning (9–12)

Beginning Scholar: Shakespeare Conquest + scholar club

Intermediate Scholar: Shakespeare Conquest + Pyramid Project

Advanced Scholar: Quest 3 + Pyramid Project (TERM 1) Shakespeare Conquest + Pyramid Project (TERM 2)

Date of Birth

MM

DD

YYYY

Child #3 Name

First Name

Last Name

What phase of learning is this child in?

Core Phase Babies (0–5)

Core Phase Kids (5–8)

Love of Learning (9–12)

Beginning Scholar: Shakespeare Conquest + scholar c

Intermediate Scholar: Shakespeare Conquest + Pyramid Project

Advanced Scholar: Quest 3 + Pyramid Project (TERM 1) Shakespeare Conquest + Pyramid Project (TERM 2)

Date of Birth

MM

DD

YYYY

Child #4 Name

First Name

Last Name

What phase of learning is this child in?

Core Phase Babies (0–5)

Core Phase Kids (5–8)

Love of Learning (9–12)

Beginning Scholar: Shakespeare Conquest + scholar club

Intermediate Scholar: Shakespeare Conquest + Pyramid Project

Advanced Scholar: Quest 3 + Pyramid Project (TERM 1) Shakespeare Conquest + Pyramid Project (TERM 2)

Date of Birth

MM

DD

YYYY

Child #5 Name

First Name

Last Name

What phase of learning is this child in?

Core Phase Babies (0–5)

Core Phase Kids (5–8)

Love of Learning (9–12)

Beginning Scholar: Shakespeare Conquest + scholar club

Intermediate Scholar: Shakespeare Conquest + Pyramid Project

Advanced Scholar: Quest 3 + Pyramid Project (TERM 1) Shakespeare Conquest + Pyramid Project (TERM 2)

Date of Birth

MM

DD

YYYY

Stay on Campus *

I understand and agree to be on campus the entire commonwealth day unless my child is a drop off scholar age 12+.

Yes

All parents mentor *

I uderstand and agree to mentor classes as needed in the commonwealth and participate in Family Foundations. (Does not apply to provisional members who have only registered drop off scholar members.)

Yes

Participation *

I understand that during class hours my child(ren) have only 2 options: participate in the class they are registered for, or sit with me, their parent.

Yes

Communication about issues *

I understand that should my child(ren) be part of a conflict or behavioral issue, that their privacy will be honored, and that only the necessary mentors and relevant board members will be aware of the situation as communication with the parent(s) is pursued.

Yes

Read A Thomas Jefferson Education *

I agree to read A Thomas Jefferson Education by Oliver DeMille. This book outlines the principles and approach to Leadership Education that will be implemented in the LTI Educational Commonwealth. I agree to read this book before September 30, 2023 and to align my teaching and mentoring on commonwealth days with the Keys of Great Teaching as is appropriate within the Phases of Learning in the various Environments of Mentoring as outlined in A Thomas Jefferson Education.

Yes

Mothers of Influence *

I understand and agree that I am expected to attend at least four Mothers and Fathers of Influence discussions per year (held on the 1st Thursday of each month) in order to retain my parent or provisional membership status. I understand that I need to attend the Annual Member Meeting held in April.

Yes

BAND *

I understand and agree to have my own BAND account and to stay up-to-date on all official LTI communications. I un- derstand that BAND is LTI’s platform of communication, and that announcements will be posted on BAND only.

Yes