Food Studies Registration

Student's First Name*

Student's Last Name*

Student's Birthdate*

Student's Email*

Student's Legal/Birth Sex*

Student's Gender Identity

Current School Name*

School City*

School State*

Curent Grade*

HSGY

Physical or Learning Accommodations

Dietary Restrictions

Relationship type

Parent's First Name*

Parent's Last Name*

Mailing Address*

Country

Street

City

Region

Postal Code

Parent's Email*

Parent's Primary Phone (home phone/mobile)*

Parent's Work Phone*

Academic Interests*

Extracurricular Interests*

How did you hear about this program?*

Some financial assistance may be available. Would you like to request financial aid?

Yes

No

Please use the space below to answer the following prompt: *

Think about a food or a dish that reminds you of special times in your life, or special people. Describe it, and write a short reflection on the following: what about the food or the memory you associate with it makes it special?

This summer program is affiliated with Bard Academy at Simon’s Rock. If you receive print or online communications relating to Bard Academy programs and you wish to unsubscribe, simply select the “Unsubscribe” link at the bottom of any email communication or contact us at bardacademy@simons-rock.edu.