PA Summer Kickstart 2024

PA Summer Kickstart 2024

Date

MonthDayYear
Date
Summer Kickstart Registration
Student Address*

Street Address

Street Address Line 2

CityState

Zip Code
Number of Students*

Student Contact Information

Full Name*

First NameLast Name
Relationship*
Email*
Primary Phone Number*
Primary Phone Type*
Alternate Phone Number
Alternate Phone Type
Address (if different than child)

Street Address

Street Address Line 2

CityState

Zip Code

Full Name

First NameLast Name
Relationship
Email
Primary Phone Number
Primary Phone Type
Alternate Phone Number
Alternate Phone Type
Address (if different than child)

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact*

First NameLast Name
Relationship*
Phone Number*
Phone Type*
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Comments or Questions
Are you interested in Fall Registration at Phoenix Academy*
Registration Fee
Are you interested in Financial Aid?
What prompted you to register for Summer Kickstart?*
Tuition
Payment

Please complete your registration by submitting the $100 registration fee or $750 tuition payment to Phoenix Academy.

Balance of tuition due on or before first day of the Summer Kickstart.
Payment Option*

Credit Card/PayPalCheck

Enter Payment Amount*

USDFee/Tuition

Payment Method
Credit	Express

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Pay by Check
Please make your check for the registration fee or tuition payment payable to "Phoenix Academy" and send it to: Phoenix Academy - 1110 N 66th Street - Omaha, Nebraska 68132 - Registration is not complete until we receive the registration fee or tuition payment.
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