Anointed Scholars Enrichment Registration

Expected Start Date:

Date

1st Child Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

FemaleMale

School Attending*

Grade Entering*

T-Shirt Size*

Home Phone*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

2nd Child Name

First NameLast Name

Child Birth Date

MonthDayYear

Child Gender

FemaleMale

Child School Attending

Child Grade Entering

2nd ChildT-Shirt Size

3rd Child Name

First NameLast Name

3rd Child Birth Date

MonthDayYear

3rd Child Gender

FemaleMale

3rd Child School Attending

3rd Child Grade Entering

3rd Child T-Shirt Size

Child Name

First NameLast Name

Child Birth Date

MonthDayYear

Child Gender

FemaleMale

Child School Attending

Child Grade Entering

Child T-Shirt Size

Returning or New participant?

New Applicants Only Birth Certificate here*

Browse Files

Required Forms

Has your child had a school physical exam within 1 year from today's date or less on file?*

YesNo

Upload Medical Physical Exam here*

Browse Files

All participants must have a school physical on file prior to particapating in program

Does your child have any allergies?*

YesNo

Does your child have any medical conditions?*

If more than one child has medical conditions please include child name.

Please list all food allergies. *

If more than one child has allergies please include child name and allegies.

Does your child have any Specail Needs*

If more than one child has medical conditions please include child name.

Which Field Trips or outings that interest you?

List additional outings that interest you?

Here is a list of the Special Activities that are offered for an additional add-on to any package below, which activities interest you? These activities are available on our Shop Page via our website a-scholarsinc.com

Swim Lessons ($100 for the summer (6 sessions)Golf ($150 for the summer (5) sessions)Track & Field ($25, pratice as needed)Gymnastics ( $100 (3) sessions over the summer)Archery $100 (4) session over the summerCooking ( $45 (3) sessions over the summer)Horse/Pony Riding ($75 (3) sessions over the summer)Art Lesson ($15 per sesion (4) sessions over the summer

Full Name*

First NameLast Name

Home*

Area CodePhone Number

Cell*

Area CodePhone Number

Work

Area CodePhone Number

E-mail*

example@example.com

Address - Same As Child*

YesNo

Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Full Name

First NameLast Name

Cell

Area CodePhone Number

Home

Area CodePhone Number

Work

Area CodePhone Number

E-mail

example@example.com

Address - Same As Childs

YesNo

If your address is different than the childs please fill out the info below. Otherwise move onto the next section.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Full Name

First NameLast Name

Cell

Area CodePhone Number

Home

Area CodePhone Number

Please list the people authorized to pick up your child.

Build your own package 2024

Registration Activity Fee$200.00

Non Refundable: Includes .. Slot Holder-T-shirt, supplies, meals, sports equipment (Soccer, tennis, basketball, kickball, volley ball, roller skating lessons, and recreational equipment.

Before & After Care $150.00

Arrive before school and or enjoy after school enrichment with homework help! Snack is included! Transportation is included with-in 5 miles of campus.

Winter Break or Spring Break$150.00

Enjoy (5) days of enrichment activities. 8:30 -4:30 p.m Must pack bag lunch Field trips outings are seperate!

Summer Enrichment Six Week Package Session 1: June 17th- July 26th or Session 2: June24th - August 2nd$725.00

Enjoy six full weeks of Summer Enrichment.8:30-4:30 p.m. This package Includes: Daily meals (Breakfast & Lunch) T-shirt Reading & Math Summer Bridge Program (Keep the brain sharp for the summer) Sports: Soccer, Basketball, Biking, Kickball, Double Dutch, STEM Challenges, Arts & crafts, sewing, crochet, Young Authors Club, & Chess Not Included: Gymnastics, Swimming, Golf, Tutoring, & Horse Riding, Archery, and Cooking are Alacarte

Second Child Summer Enrichment Six Week Package Session 1: June 17th- July 26th or Session 2: June24th - August 3$725.00

Enjoy six full weeks of Summer Enrichment.8:30-4:30 p.m. This package Includes: Daily meals (Breakfast & Lunch) T-shirt Reading & Math Summer Bridge Program (Keep the brain sharp for the summer) Sports: Soccer, Basketball, Biking, Kickball, Double Dutch, STEM Challenges, Arts & crafts, sewing, crochet, Young Authors Club, & Chess Not Included: Gymnastics, Swimming, Golf, Tutoring, & Horse Riding, Archery, and Cooking are Alacarte

Payment Plan Six Week Session ( Two Payments ) $362.50

Only two payments of $362.50. Pay $362.50 today and the balance by June 7th, 2024. An invoice will be sent to the email on file allowing multiple payments. A $100 NON- Refundable Deposite is due at time of registration.

Summer Enrichment Eight Week Session 1: June 17th- August 10$960.00

Enjoy eight full weeks of Summer Enrichment. 8:30-4:30 p.m. This package Includes: Daily meals (Breakfast & Lunch) T-shirt Reading & Math Summer Bridge Program (Keep the brain sharp for the summer) Sports: Soccer, Basketball, Biking, Team Building Games, Kickball, Double Dutch, STEM Challenges, Arts & crafts, sewing, crochet, printing, journaling, poem writing, Young Authors Club, & Chess............... Not Included: Gymnastics, Swimming, Golf, Tutoring, & Horse Riding, Archery, and Cooking are Alacarte

Second Child Summer Enrichment Eight Week Session 1: June 17th- August 9th.$960.00

Enjoy eight full weeks of Summer Enrichment. 8:30-4:30 p.m. This package Includes: Daily meals (Breakfast & Lunch) T-shirt Reading & Math Summer Bridge Program (Keep the brain sharp for the summer) Sports: Soccer, Basketball, Biking, Team Building Games, Kickball, Double Dutch, STEM Challenges, Arts & crafts, sewing, crochet, printing, journaling, poem writing, Young Authors Club, & Chess............... Not Included: Gymnastics, Swimming, Golf, Tutoring, & Horse Riding, Archery, and Cooking are Alacarte

Payment Plan Eight Week Session (Two Installments)$480.00

Only two payments of $480. Pay $480 today and the rest by June 7th, 2024. An invoice will be sent to the email on file allowing multiple payments. A $100 NON-Refundable Deposit is due at time of registration.

Enter coupon

Total $0.00

List additional activities that interest you

Who reffered you to our program?*

Rules & Policies:*

Yes, I understand that my child may be required to wear a mask for all indoor activities daily and must adhere to all safety guidelines.Yes, I understand that my child/ren will need a water bottle daily. Drinking fountains will not be available due to COVID-19.Yes, I understand that my child/ren MUST bring gym shoes for everyday sports and activities. An additional pair of indoor shoes are required to help cut down the spread of germs.Yes, I understand that my child/ren MUST attend summer enrichment in good health. If any symptoms are present, the participant will be isolated, and a parent will be called to take the participant home. Due to COVID-19 a doctor's note and or negative COVID test MUST be received before participants can to return. As stated in Anointed Scholars Inc. Policy and Procedures.Yes, I understand before start date all participants must have an negative COVID-19 test on file.I understand that all registration, supply fees, special activities must be paid prior to start date.

I am the legal parent /guardian and I give permission for my child to participate in all activities given. I release Anointed Scholars to take photograph, videotape and digital record during regular program hours. Though the names of faculty, staff, and administration can be used, it is our policy that full names of participants will not. Occasionally it might be necessary to use the first name but never the last name, address, or phone number of participant.*

Yes, I consentNo, I do not consent

I have read, and fully understand all policy and procedures and adhere to all Anointed Scholars Policies as it relates to COVID-19 and Anointed Scholars Program Policy. If I registered via fax or on-line my e-signature will have the same legal entitlement (Please READ our program policy)*

Yes

Late Pick Up Policy. There is a $10 late fee charged after the first 5 minutes and an additional $2 per minute there after. Late fee must be paid by the following morning, or children may not be allowed to participate in program*

I understand the late fee policy, and will comply

Field Trips. I understand that camp activities include weekly field trips conducted off the A-Scholars premises under adult supervision. Therefore, I:*

give permission for my child to attend outings off A-Scholars campusdo not give permission for my child to attend outing of A-Scholars campus

Field Trips. I understand that camp activities include weekly field trips conducted off the A-Scholars premises under adult supervision. Therefore, I:*

give permission for my child to attend outings off A-Scholars campusdo not give permission for my child to attend outing of A-Scholars campus

PHOTO/VIDEO RELEASE On occasion, Annointed Scholars take photographs or make an audio or videotape recording of children. Such photographs and audio/visual recordings may be used in A-Scholars social media, or advertising materials.*

I consentdo not give permission for my child to be photographaed

Participant RELEASE POLICY
It is our intent that children attending camp do so for the entire day. There are, however, emergency situations when campers must leave early. In those
cases, campers will be released to a legal parent/guardian whose name appears on the Particpant Information Form. Campers WILL NOT be released to any other person without written consent signed by the legal parent/guardian and prior notification to the day camp office: 312-798-9046 Thank you for yourcooperation with this policy intended to promote your child’s safety.

INFORMED CONSENT POLICY
We are concerned with your child’s safety and well-being. participants activities involve risk. Activities involving risk can help a child grow in confidence and
expand their life experience. This policy requires a parent/guardian’s approval to allow their child’s participation in “high-adventure” activities. This policy
applies only to high risk activities. Other inherent risks exist in the program experience and environment and are not addressed in this policy. High-adventure activities may include: archery, climbing wall, swimming, sports, recreation and waterslide rides.

FACE COVERING/MASK
All participants and staff will be required to wear face coverings that cover both their nose and mouth at all times while inside building. Participants will need to bring their own face coverings that may be comfortably worn throughout the day.

Signature

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Anointed Scholars Inc. Enrichment Registration

2024

How it works...

Child Information

2nd Child Information

3rd Child Information

4th Child Information

Medical, Allergies, Document Upload

Field Trips

Special Activities

Parent/Guardian Information 1

Parent/Guardian Information 2

Emergency Contact - Other than Parent/Guardian

Select a Package below!

Anointed Scholars Policy