PA Summer Kickstart 2017

Student 1 (click here)
Student Name *

First Name Last Name
Preferred Name
Birth Date *

Month Day Year
Gender *
Current School *
School District
Grade Fall 2022 *
Hispanic or Latino? *

Yes No
Race *

Asian Black or African American White American Indian or Alaska Native Other Native Hawaiian or Other Pacific Islander
Allergies
Medications

Student 2 (click here)
Student Name *

First Name Last Name
Preferred Name
Birth Date *

Month Day Year
Gender *
Current School *
School District
Grade Fall 2022 *
Hispanic or Latino? *

Yes No
Race *

Asian Black or African American White American Indian or Alaska Native Other Native Hawaiian or Other Pacific Islander
Allergies
Medications

Student 3 (click here)
Student Name *

First Name Last Name
Preferred Name
Birth Date *

Month Day Year
Gender *
Current School *
School District
Grade Fall 2022 *
Hispanic or Latino? *

Yes No
Race *

Asian Black or African American White American Indian or Alaska Native Other Native Hawaiian or Other Pacific Islander
Allergies
Medications

Student 4 (click here)
Student Name *

First Name Last Name
Preferred Name
Birth Date *

Month Day Year
Gender *
Current School *
School District
Grade Fall 2022 *
Hispanic or Latino? *

Yes No
Race *

Asian Black or African American White American Indian or Alaska Native Other Native Hawaiian or Other Pacific Islander
Allergies
Medications

Stopper
Comments or Questions
Are you interested in Fall Registration at Phoenix Academy
Are you interested in applying for financial aid?
What prompted you to register for Summer Kickstart? *
Registration Fee
Tuition
Payment

Please complete your registration by submitting the $100 registration fee or $750 tuition payment to Phoenix Academy.

Balance of tuition due on or before first day of the Summer Kickstart.
Payment Option *

Credit Card/PayPal Check

Enter Payment Amount *

USD Fee/Tuition

Payment Method

Pay by Check
Please make your check for the registration fee or tuition payment payable to "Phoenix Academy" and send it to: Phoenix Academy - 1110 N 66th Street - Omaha, Nebraska 68132 - Registration is not complete until we receive the registration fee or tuition payment.
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Summer Kickstart Registration