Summer Kindergarten Readiness Registration Application

Summer Kindergarten Readiness Registration Application - 7 Weeks

Generations Preparatory Academy by Generations Youth and Community Center, INC.
Student Information

Student must be 5 years of age by September 1st or currently in Kindergarten.
Name*

First NameLast Name
Grade*
School Last Attended*
School Attending in the Fall 2023-2024*
Gender*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Email*
example@example.com
Do you have any educational concerns? (N/A if no concerns)*
Student has an IEP?*

YesNo
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first*
Who may the student be released to?*
Emergency Information
Name*

First NameLast Name
Relationship*
Phone Number*
Health Information
Family Doctor*

First NameLast Name
Office Address*
Phone Number*
Please let us know if this child have any allergies*
List medications if this child is currently taking*
Have this child had any serious illnesses or operations?*

YesNo
If yes, please describe
Summer School Programs
Registration Fee: $25 (Holds your Students Spot)

Program: Monday - Thursday 8:30am-12:00pm

Weekly Payment, Due each Monday: $125 or Summer Payment: $755

(Included Educational Program, morning and afternoon snack each day.)

Once your Registration Application and fee is received, you will receive a confirmation email with the program outline and protocols.

Program Dates: June 26, 2023-August 10, 2023

Registration (Non-Refundable) *

2023 Summer Kindergarten Readiness Registration Fee

$25.00 Quantity

Total

$0.00

Credit Card

Apple Pay

Cash App Pay

Signature* Signing below indicates that you agree to the payment option and program terms above.*

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Summer Kindergarten Readiness Registration Application - 7 Weeks