Summer Specialised Academics Form

Select Summer Intensive Learning Programme

Choose week(s)

Assessment Request

Preferred Time Part-Time

Preferred Time 1-Hour Intensive

Preferred Time 2-Hour Intensive

Preferred Time Half-Day Intensive

Preferred Time 4-Weeks Intensive

Preferred Time Arrowsmith Cognitive Programme

Student Name

First NameMiddle NameLast Name

School

Grade/Year of Child

Date of Birth

MonthDayYear

Gender

Parent / Guardian Full Name

First NameLast Name

Mother Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Mother Work Number

Please enter a valid phone number.Format: (000) 000-0000.

Father Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Father Work Number

Please enter a valid phone number.Format: (000) 000-0000.

Mother Email Address

example@example.com

Father Email Address

example@example.com

Address

Street Address

P.O. Box

CityState / Province

Postal / Zip Code

Emergency Contact Name

First NameLast Name

Emergency Phone Number

Format: (000) 000-0000.

Is the student allergic to any medications or foods or have any physical conditions (i.e. asthma, diabetes, etc.)?

Additional Notes:

Arrrowsmith Programme Terms & Conditions

(Arrowsmith Cognitive Intensive Programme – Summer)

1. Fees & Payment
A non-refundable deposit of $600 KYD is required to secure a place.
The remaining balance is payable as follows:
$1,600 KYD due prior to the programme start date
$1,000 KYD due by the end of Week 1

All fees must be paid in full within the programme period.
A student’s place is not confirmed until the deposit has been received.

2. Refund Policy
The deposit is non-refundable under all circumstances.
Once the programme has commenced, no refunds or credits will be issued for:
missed sessions
early withdrawal
absence for any reason

In exceptional circumstances (e.g. medical), partial consideration may be given at the discretion of the centre.

3. Withdrawal

Written notice is required for any withdrawal prior to the programme start date.

If a student withdraws:
before the start date → deposit is retained
after the programme begins → full programme fees remain payable

4. Attendance & Commitment
This is a structured intensive programme requiring consistent daily attendance.
Enrolment is for the full 4-week programme; partial attendance is not available.
No make-up sessions are provided for missed days.

5. Programme Delivery
The programme is delivered in accordance with the Arrowsmith Program guidelines.
Scheduling and grouping are determined by the centre to ensure effective delivery.

6. Programme Suitability
The programme is designed for students aged 9 years and above.
The centre reserves the right to determine programme suitability and placement.

7. Changes & Cancellation
The centre reserves the right to make reasonable changes to scheduling or staffing if required.
In the unlikely event that the programme is cancelled by the centre, a full refund will be issued.

Parent / Guardian Signature

Date

Summer Specialised Academics Form

Parent / Guardian Information