Summer in a Box 2026
Parent/Guardian Name:
*
First Name
Last Name
Email Address:
*
example@example.com
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Shipping Address for Supplies:
*
Street Address
Street Address Line 2
City
Province
Postal Code
Learner Information
Learner Name:
*
First Name
Last Name
Learner Email Address:
example@example.com
Learner Grade:
*
Please Select
Primary
1
2
3
4
5
6
7
8
9
10
11
12
Other
If Other, please specify grade:
*
EST / Itinerant Teacher Name:
First Name
Last Name
EST / Itinerant Teacher Email Address:
School Information
School District/Regional Centre for Education:
*
Please Select
First Nations School
NB - Anglophone North - Miramichi
NB - Anglophone South - Saint John
NB - Anglophone East - Moncton
NB - Anglophone West - Fredericton
NFLD - English School District
NS - Annapolis Valley Regional Education Centre
NS - Cape Breton-Victoria Regional Education Centre
NS - Chignecto-Central Regional Education Centre
NS - Conseil scolaire acadien provincial
NS - Halifax Regional Education Centre
NS - Mi’kmaw Kina’matnewey (MK)
NS - South Shore Regional Education Centre
NS - Strait Regional Education Centre
NS - Tri-County Regional Education Centre
PEI - First Nations School District
PEI - Public Schools Branch
School Name:
*
Session Selection
Which week/s can the learner and sibling/s attend?
*
Week 1 - July 15, 2026
Week 2 - July 22, 2026
Additional Participants
How many other people will be attending (adults and children):
*
Please Select
0
1
2
3
4
5
1) Additional Participant
1) Participant Name:
First Name
Last Name
1) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
1) Participant Age:
*
2) Additional Participant
2) Participant Name:
First Name
Last Name
2) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
2) Participant Age:
*
3) Additional Participant
3) Participant Name:
First Name
Last Name
3) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
3) Participant Age:
*
4) Additional Participant
4) Participant Name:
First Name
Last Name
4) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
4) Participant Age:
*
5) Additional Participant
5) Participant Name:
First Name
Last Name
5) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
5) Participant Age:
*
End of Form
Include any information about access needs, cultural and identity considerations.
Feedback
How did you hear about this program?
*
Please Select
APSEA Website
Facebook
APSEA Email
APSEA Event Postcard
APSEA Service Delivery Team Meeting
APSEA Specialist
Word of Mouth
Other
If Other for how you found out about this program, please specify
Register for Program
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