Register — Lumos Writing Academy 2026

Your writer & weeks

Add each child you're registering and choose their weeks. The full three-week program is where the real transformation happens.

Parent / guardian

We'll use this to confirm your spot and share camp updates.

Full Name *

Phone Number *

Email *

Emergency contact

Someone we can reach if you're unavailable during camp hours.

Same as parent / guardian above

Full Name *

Phone Number *

Relationship to Child *

About your writer

This helps Dr. Arora tailor the experience to each child before day one.

How does your child currently feel about writing? *

Loves it — writes for fun already

Fine with it — does well but isn't excited

Reluctant — writing is a struggle or a battle

Not sure

What are your child's interests?

This helps Dr. Arora bring in examples and encouragement that click for your child. The class works with one shared topic so everyone's ready to debate each other.

Allergies or medical notes we should know about

Review & submit

Read and sign the participation agreement, then confirm payment details.

Participation Agreement & Media Release

I, the undersigned parent or legal guardian of the above-named child, give permission for my child to participate in the Lumos Writing Academy program, a small-group academic writing and public-speaking enrichment program held at the instructor's private residence in Chino Hills, CA.

Nature of the program: this is an academic enrichment program and does not include any physical, athletic, or contact activities. I understand that ordinary risks common to any small-group, in-home learning environment may apply (for example, minor incidental injury, food allergies, or typical household hazards), and I accept those risks on behalf of my child.

Premises: sessions are held at a private home. I agree to drop off and pick up my child promptly at scheduled times and to remain reachable during session hours. Supervision is provided during scheduled session hours only.

I certify that the health information I have provided is accurate, and I authorize program staff to seek emergency medical treatment for my child if necessary and I cannot be reached.

I understand that photos or videos taken during camp sessions may be used for training review, promotional materials, and future educational content, and may appear on our website or social media. I may opt out by contacting support@lumoswriting.com.

Intellectual property: my child's original written work remains my child's own. I grant the program a non-exclusive right to reproduce excerpts of that work (with my child identified only by first name or initials) in instructional or promotional materials.

Refund policy: full refund any time before camp begins; prorated refund through the end of week one. No refunds after week one, except at the program's discretion.

I release and discharge the Lumos Writing Academy, its instructor, and affiliates from liability for claims arising from ordinary participation in the program or presence at the instructor's residence during scheduled sessions, except claims arising from gross negligence or willful misconduct.

I have read and agree to the participation agreement on behalf of myself and my minor child. *

Parent / Guardian Signature *

Draw your signature below using your mouse or finger:

Print Your Full Name *

Date Signed

I understand my child's spot is not reserved until Zelle payment is received at 951-733-8599. I will include my child's name in the Zelle note. *

How did you hear about us? *

Flyer

Instagram

Friend or neighbor

Nextdoor or local Facebook group

Agility Training Academy family

Other