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Summer Camp Registration

ELA Summer Application - PK-12 (2026)

Knowledge Quest Extended Learning Academies Summer Programming Register Pre-Kindergarten-8th Grade students for daily summer programming in Knowledge Quest's Extended Learning Academies.

"*" indicates required fields

Step 1 of 8

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ELAP + S2

KQ Extended Learning Academy Summer Application

Please fill out this application carefully and double check to ensure that all information provided is accurate and correct (including spelling).
MM slash DD slash YYYY
Select today's date.

Family History with Knowledge Quest

Please provide all information about previous enrollment or participation that this child or other family members have had with Knowledge Quest programming.

Participant Information

Provide information about your child. Please check to ensure accuracy!
Name:*
Date of Birth:*
Gender:*
Please enter a number from 4 to 19.
Race:*
Select all that apply.
Ethnicity*
Is the home address the same as what was listed in the 2025-2026 application?*
Home Address:*
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Parent or Guardian Information

Provide information for the primary caregiver for this child.
Guardian Name*
Is this person completing the form?*
Person Completing Form
Guardian Address*
Who is the child's Legal Guardian?*

Parent Guardian Additional Information

Please provide demographic information about the parent/guardian listed above.
Employment Status:*

Parent/Guardian Information #2

Optional: contact information for a second parent or guardian.
Parent/Guardian Name:*
Address*
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Employment Status:*

School Information

Please provide information about the school and grade that this participant attended this most recent school year (2025-2026).
Please note that beginning this summer, students will be considered in the grade they most recently completed.
Does student receive additional Educational Programs & Services through school?*

Household Information

Please provide accurate demographic information about the household. This information is for data purposes and will not be shared.
Type of Residence*

Rehousing or Homelessness in past 18 months?*
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List all siblings currently enrolling in Summer ELA (add a new row for each):
First Name
Last Name
 
Annual Household Income*
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Have utilities been disconnected in the past 18 months?

Participant Medical Information

It is the responsibility of the Parent or Guardian to provide Knowledge Quest with specific emergency procedures.
Are there any medical conditions or specifications? (allergies, medical issues, food requirements, etc.)*
If yes, list conditions/concerns (add a new row for each):
Does participant have a regular Primary Physician or Pediatrician?*
Name of Physician:*
Emergency Treatment Authorization*
By checking this box, I am indicating consent and authorizing Knowledge Quest to provide first aid and/or to secure medical care in the case of an emergency for the child named on this application. I authorize the physician or hospital I provided in this section to treat my child in the event of an emergency. If this physician or hospital is not available or cannot be reached, I consent to care and treatment being administered by another licensed physician or treatment facility. I realize that I will be responsible for any costs of treatment. I will not hold Knowledge Quest or any of its staff or affiliates liable.

Dismissal Information

What is the child's mode of transportation?*
Independent Walker Release*
My child has permission to sign himself or herself in and out of KQ programming. I give consent for my child to be released as an independent walker and leave at the end of programming without adult supervision. Knowledge Quest will not be responsible for my child when they leave the program.

MODE OF TRANSPORTATION: By indicating that your child is a walker you agree to indemnify and hold Knowledge Quest, its employees, board of directors, and/affiliates harmless of any such claim, demand, cause of action or any legal or equitable action arising out of relating to your child/children in said mode of transportation. As parent/legal guardian. I waive any rights to litigation regarding accident, injury, and/or expiry after my child has been dismissed from Knowledge Quest.
List who child will walk home with (add a new row for each):*
List those (other than parents/guardians listed above) authorized for pick up (add a new row for each):*
First Name
Last Name
Relationship
Phone
 

Emergency Contacts

Please provide contact information for at least one additional adult (other than parent/guardians listed above) to contact in case of emergency. You can add a row for each emergency contact.
Additional Emergency Contact(s) (add a new row for each):*
First Name
Last Name
Relationship
Phone
 

Consents & Authorization

Please read the statements below carefully.
Media Release*
I grant permission to Knowledge Quest to use my child's image may be used by Knowledge Quest. This consent includes the purposes of promoting the Extended Learning Academy, Knowledge Quest, and other related programs in various material and forms of media.
Feedback Consent*
I consent to having my child provide feedback regarding their experience at the Extended Learning Academy for improvement and reporting purposes.
Statement of Consent for Activities*
I give my permission for the child named on this application to engage in all off and on campus learning, recreational, and field trip experiences provided through Knowledge Quest programming during and after standard operation hours.

I agree to release Knowledge Quest, its employees, and affiliates from liability for injuries or loss of life resulting from or occurring during these activities as a result of regular program operations.
Statement of Indemnification*
I hereby release and hold harmless Knowledge Quest, its employees, board of directors, and/or affiliates from any liability which may arise out of or in connection with my child/children's traveling as a part of Knowledge Quest, including, but not limited to potential claims, demands and causes or action for compensatory or punitive damages, attorney fees, costs, and other legal or equitable relief of any other legal or equitable relief of any kind, for injuries and damages, and the consequences thereof, whether known or unknown, foreseen or unforeseen, arising out of or resulting from Knowledge Quest, its staff, its affiliates or representatives.

I further agree to indemnify and hold Knowledge Quest, its employees, board of directors, and/or affiliates harmless of any such claim, demand, cause of action or any legal or equitable action arising out of relating to my child(ren) in said event. As parent/legal guardian, I waive any rights to litigation regarding accident, injury, and/or expiry through my child's participation in the program.
School Information Consent*
As a participant in Knowledge Quest's Extended Learning Academy programming, your child receives education support services designed to ensure students succeed academically. This program is monitored through the Tennessee Department of Education. As such, it is vital that KQ has access to your student's records. As a part of program enrollment, Knowledge Quest requests written access to information about a student that is connected to a student's identity, including demographic information, grades, test scores, progress reports, attendance records, discipline records, student ID number, and registration records.

The Family Education Rights and Privacy Act (FERPA) protects students and parents by prohibiting most third parties, including Knowledge Quest, from accessing student records, information, or data without written permission from a parent or guardian if the student is under 18.

The purpose for accessing or sharing education records, information, or data related to your student is to better provide education support services and meet the reporting requirements set forth by the Department of Education. No records, information, or data will be used for any other purpose than those of service differentiation or improvement and reporting.

By consenting below, you are giving written permission for education records, information, or data about your student to be shared with Knowledge Quest. This information may come directly from the school, Memphis-Shelby County School District, or through partnership with Seeding Success.

Records and information from records will not be shared or given to anyone other than the parties mentioned above.

You have the right to revoke this consent at any time if you do not want records, information, or data shared, or if you do not believe the sharing of records, information, or data is in the best interest of your student. You also have the right to obtain copies of any information about your student that is shared as a result of this form. Should you wish to revoke this consent, you must provide to Knowledge Quest written notice of your decision to revoke. Unless and until this revocation is made, this consent shall remain in effect until your student turns 18.
Clear Signature
Date*
Drop files here or
Max. file size: 1 GB.
    25-26 Report Card: Please upload a PDF or picture (must be clear and show entire page) of the student's final report card from the current school year (2025-2026). This must be submitted before your student can begin attending programming.
    Drop files here or
    Max. file size: 1 GB.
      24-25 Report Card: Please upload a PDF or picture (must be clear and show entire page) of the student's final report card from last school year (2024-2025). This must be submitted before your student can begin attending programming.
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      Max. file size: 1 GB.
      25-26 TCAP Scores: For students grades 4th - 8th, please upload a PDF or picture (must be clear and show entire page) of the student's MATH and READING assessment scores from Spring 2026. This must be submitted before your student can begin attending programming.
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      Max. file size: 1 GB.
      23-24 TCAP Scores: For students grades 4th - 8th, please upload a PDF or picture (must be clear and show entire page) of the student's MATH and READING assessment scores from Spring 2024. This must be submitted before your student can begin attending programming.

      Family Stability Center - Family Coaches

      As a part of your Knowledge Quest membership, all families receive a Family Coach through the KQ Family Stability Center. You can pre-register for a Family Coach on our website if you do not currently have one. A coach will be in touch with you soon!

      Thank you for being a Knowledge Quest member!

      Statement of Confirmation*
      By checking this box I am confirming that I have completed this application to the best of my ability in all honesty. I am the parent/legal guardian of the child listed above. I give my permission for his/her participation in Knowledge Quest programming.

      Gaston Park Campus

      Gaston Park
      1044 South 3rd St.
      Memphis, TN. 38106

      College Park Campus

      College Park
      990 College Park Dr. #104
      Memphis, TN. 38126
      PH: 901-207-3694

      Main Campus

      Main Campus
      590 Jennette Pl
      Memphis, TN. 38126
      PH: 901-942-1512

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