School Age Support

School Age Support Application

No Deposit/Enrollment Fee Special!
Hours available: 7 am-6 pm

Afterschool: 3-6 pm, stem hands-on experiments, and activities

Meals and snacks included

Examples: viewing specimens with a real microscope, make your own slime, make your own lava lamp, make fake snow, design a snowflake, stem skiing challenge, make your own lip gloss, build a glowing circuit Christmas tree & so much more.

Tuition:$1000 per month or $275 per week

Save $1000-no enrollment fee for January or February enrollment
Email *
example@example.com
Parents Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Students Name *

First Name Last Name
Students Name

First Name Last Name
Students Name

First Name Last Name
Students Name

First Name Last Name
Schools Name & Address *
Students Grade for the 2020-2021 School Year *
Students Grade for the 2020-2021 School Year
Students Grade for the 2020-2021 School Year
Students Grade for the 2020-2021 School Year
What date are you interested in starting (must be the 1st week of the month) *

Month Day Year
Date
Whats day(s) will your student report to school in person

Monday Tuesday Wednesday Thursday Friday
Whats day(s) will your student attend school virtually

Monday Tuesday Wednesday Thursday Friday
What day(s) are you interested in school age support and/or tutoring? *

Monday Tuesday Wednesday Thursday Friday Saturday
Does your student need a chrome book? If no, we can loan one to you. *

Yes No
Does your student have an IEP *

Yes No
State Subsidy *

Yes No
If yes, please provide further detail. Please also email a copy of the students most recent IEP no later than 7 days prior to the start date at: founder@esteemgirls.org
Signature *

Clear

Registration

Non-Refundable Application Fee $ 26.06

Required for each student registered

Quantity

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty:

School Age Support Application