Elsass Academy Summer Application
Parent 1 Full Name
*
Parent 2 Full Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 1 Number
*
-
Area Code
Phone Number
Parent 2 Number
-
Area Code
Phone Number
Parent 1 Email
*
example@example.com
Parent 2 Email
example@example.com
First Child Information
Last Name
*
First Name
*
Sex
*
Male
Female
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
Grade (Going In To)
*
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
Current Age
*
Summer Program
*
Term 1: June 6 - July 8 (5 weeks) for $1295
Term 2: July 11 - Aug 12 (5 weeks) for $1295
All Summer Option for $2400
All Summer option is broken into 3 payments
Payment Dates: 6/1, 7/5, and 8/1
Special Information Concerning Child:
Second Child Information
Do you have a second child?
No
Yes
Last Name
First Name
Sex
Male
Female
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Grade (Going In To)
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
Current Age
Summer Program
Term 1: June 6 - July 8 (5 weeks) for $1295
Term 2: July 11 - Aug 12 (5 weeks) for $1295
All Summer Option for $2400
All Summer option is broken into 3 payments
Payment Dates: 6/1, 7/5, and 8/1
Special Information Concerning Child:
Signature
Clear
Submit
Should be Empty: