All Academic Access Summer Enrichment Registration Form

All Academic Access Summer Enrichment Registration Form
Student Information
Name

First NameLast Name
Upcoming Grade
School Last Attended
Gender
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Email
example@example.com
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first*
Emergency Information
Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
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Do you want to indicate any related information?
Summer Enrichment Programs
Tutoring (8 sessions/Monthly )$350.00

Sessions are Eastern Standard Time

Upcoming Grades: 2nd-6th

Subjects: Reading, Writing, Test Prep.

Days: Monday-Thursday 2 Sessions Weekly

Time Slots: 9:00-10:00 10:00-11:00 11:00- 12:00 (ET)

Book Club $99.00

Upcoming Grades: 3rd-5th

Days: Monday and Wedsnesday

Time Slot (ET): 6:00-7:00 p.m.

Upcoming Grades: 6th-8th

Days:Tuesday and Thursday

Time Slot (ET) 6:00-7:00 pmm.

Upcoming Grades: 9th -12th

Days: Monday and Wednesday

Time Slot (ET): 5:00-6:00 p.m.

STEM Enrichment $50.00

Upcoming Grades: 3rd-5th

Day: Friday Only

Time Slot (ET): 6-7 p.m.

*All purchases final. No refunds on sessions.

*All Sessions are on Eastern Standard Time.

Entering Grades 3rd-5th Mon. and Wed. 6:30-7:30 p.m.

Rows	Session A (June 1 to 30)	Session B (July 3 to 28)
Book Club ($99)
Academic Tutoring ($350)
STEM ($50)

Entering Grades 6th-8th Tuesday and Thursday 6:00-7:00 p.m.

Rows	Session A (June 1 to 30)	Session B (July 3 to 28)
Book Club ($99)
Academic Tutoring ($350)
STEM ($50)

Entering Grades 9th-12th Monday and Wednesday 5:00-6:00 p.m.

Rows	Session A (June 1 to 30)	Session B (July 3 to 28)
Book Club ($99)

Entering Grades 6th-8th Tuesday and Thursday 6:00-7:00 p.m.

Rows	Session A (June 1 to 30)	Session B (July 3 to 28)
Book Club ($99)
Academic Tutoring ($350)
STEM ($50)

Total
Signature
Date of Registration

MonthDayYear
Date

My Products

Book Club

$99.00 Quantity

Tutoring

$350.00 Quantity

STEM

$50.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

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