Aventuras After School Enrichment Registration

CHILD INFORMATION
Child Name *

First Name Middle Name Last Name Suffix
Preferred Name
Gender *
Birthdate *

Month Day Year
Child's Picture *
What elementary school will your child be attending during the 2022-2023 school year? *
If "other" please note your child's elementary school below:
What grade will your child be entering during the 2022-2023 school year? *
How many days per week will your child be enrolling in Aventuras After School Enrichment? *
If your child is enrolling on a part-time schedule, please note your preferred schedule below:
T-Shirt Size *
How did you hear about us? *
Help Us Get to Know Your Child!
What are your child's favorite subjects in school? *
What are your child's hobbies and interests? *
Does your child participate in any classes or activities other than Aventuras? *
What is your child's familiarity or proficiency with the Spanish language? *
Does your child have any special needs? (academic, nutritional, emotional, social, etc.) *

Yes No
Please describe your child's special needs. *
Academic, nutritional, emotional, social, etc.
Does your child have an Individualized Education Program (IEP)? *

Yes No
Please share more about your child's Individualized Education Program (IEP). *
Has your child ever received any type of academic or school disciplinary action at their current or previous school? *

Yes No
Please explain any type of academy or school disciplinary action your child received at their current or previous school. *

PARENT/GUARDIAN CONTACT INFORMATION
Parent/Guardian Contact #1
Name *

Prefix First Name Last Name Suffix
Address *

Street Address

Street Address Line 2

City State

Zip Code
Primary Phone Number *

Area Code Phone Number
Alternate Phone Number *

Area Code Phone Number
E-mail *
example@example.com
Parent/Guardian Contact #2
Name

Prefix First Name Last Name Suffix
Address

Street Address

Street Address Line 2

City State

Zip Code
Primary Phone Number

Area Code Phone Number
Alternate Phone Number

Area Code Phone Number
E-mail
example@example.com
Emergency or Alternate Contact
Name *

Prefix First Name Last Name
Relation *
Primary Phone Number *

Area Code Phone Number
Alternate Phone Number *

Area Code Phone Number
Pickup Authorization

Please list the name/names of all persons authorized to pick up your child.
Name *
Phone Number *

Area Code Phone Number
Name *
Phone Number *

Area Code Phone Number
Name
Phone Number

Area Code Phone Number
Name
Phone Number

Area Code Phone Number

COMMITMENT ACKNOWLEDGEMENT & SIGNATURE
Form Upload
Please upload your Health Inventory, Immunization Certificate, Medication Administration and Tuition Express Forms here. *

Browse Files

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By signing and completing Aventuras After School Enrichment Registration, I confirm my intent to enroll my child in Aventuras for the 2022-2023 school year. I agree to pay the $150 registration fee and authorize Whole Kids Academy & Aventuras to use my Tuition Express account for monthly tuition payments. *

Yes, I agree to register my child for Aventuras After School Enrichment program and confirm that the information I have provided above is complete and accurate.
Name *

First Name Last Name
Signature *

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Aventuras After School Enrichment