Infinite Mindz

The following contract is between Infinite Mind'z and the student and/or Parent (s) of the student. Infinite Mind'z Summer Enrichment Pod's Services , are housed in inviting settings, and is the best alternative there is for working parents.

We provides a small secure environment for children and adolescents during the most momentous times of their development. Learning Pod Services offers a home away from home, where homeschool students, test taking students and life-long learners will be enriched and educated at their pace in private pods. Younger students will engage with “pod siblings” to play, socialize, and learn with, at a group no greater than 5.

Infinite Mind'z Enrichment Summer Learning Pods provides:

A safe, nurturing, learning environment. Please remember parents are responsible for transportation to pods.*

Please Initial after Reading the hovered information.

A proper approach to behavior management and/or discipline *

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And to foster unconditional love.*

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This is a safe space for BIPOC and LGBTQA+ populations, both staff and students alike.

Please Initial after Reading the hovered information.

Communication is key to any successful Pod Services partnership. The student and/or parent and Pod’s Instructor need to have a good working relationship, to effectively communicate and work together, for the best educational outcome of the student (s). *

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Students and/or Parent(s), and B. E. R. R. Staff need to exchange pertinent information in the student's life such as changes in routine, unique events or activities, as well as changes such as death, divorce, separation, moving, visitors, etc. All this information can be important in understanding the student's feelings, behavior, and well-being to approach the day learning in the best way for the student. *

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We invite you to share with us in writing, by telephone, or schedule an appointment to talk about your concerns on any area that you feel we are neglecting, and we will do my best to improve in it. (Program link will be provided once accepted into program) *

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Student Information

Name*

PrefixFirst NameMiddle NameLast Name

Birth Date *

MonthDayYear

Gender

Ethnicity

Email Address*

School Name and Address*

If you are here for Test Prep Say Test Prep

Grade*

If you are here for Test Prep Say Test Prep

Have you previously applied to or attended Infinite Mindz Learning Pod's Program?*

YesNo

If yes, what year?

How long? (in years, months, weeks, or days).

Current Residence Information

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number*

Area CodePhone Number

Cell Phone Number

Area CodePhone Number

Primary Residence Information for Parent (if different from above)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact 1

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Emergency Contact 2

Name

First NameLast Name

Phone Number

Area CodePhone Number

Medical Information In case of Emergency.

Preferred Hospital*

Insurance/Health Coverage (Company)

Please list any of the following: Current medications, Medication allergies, Food allergies (food provided in program), Chronic health concerns, including mental health and learning disabilities.*

If none Please put N/A

Previous School 1

School Name

City

State

Date Started

MonthDayYear

Date Ended

MonthDayYear

School Name

City

State

Date Started

MonthDayYear

Date Ended

Date

Standard Rates and Payment Policies

A registration fee of $5 is required before your registration form will be accepted. This can be paid below.*

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Summer Payments are due by July 14th, 2025 or a late fee of $2 will be applied to your students account. The summer fee is $100 which covers the entire 8 weeks of summer programming. This can be paid below or, through your brightwheel billing account once set up. If not paid by date this will hinder your youth from participating camp and in any field trips or receiving incentives going forward.*

Please initial to say you checked my calendar before choosing times.

With proper cancellation notice a 50% refund can be given, as a credit to your account or arrangements for another date and time can be arranged. No full refunds provided.*

Please initial to say you checked my calendar before choosing times.

Please provide any other vital information you think we may need to know in the event of an emergency. Thank you.

My child does not like to be touched.

I consent to Infinite Mind'z Summer Enrichment Learning Pod's to utilize the information provided about me and/or my youth to provide the best additional, educational services to us. I also consent to photos and videos to be taken of my child.*

YesNo

Authorized Pick Up 1

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Authorized Pick Up 2

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Authorized Pick Up 3

Name

First NameLast Name

Phone Number

Area CodePhone Number

Once you are done with this application Please go to this link: https://form.jotform.com/222105094359049 to fill out our Permission & Photo/Video Release Form. This ensures our scholar can participate to the max of his/her abilities.

Your scholar will fill out this Self Inventory Survey (Needs to be done by the end of first week. Does not have to be done to be accepted in the program. This will allow staff to get to know our scholar just a little bit. https://form.jotform.com/220695875327164

My Products

Application FeeDue before the Application will be Processed.

$15.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Parent's Name

First NameLast Name

Signature of Parent*

Date Submitted

MonthDayYear