Clone of PA Summer Kickstart 2025

Date

MonthDayYear
Date
Summer Kickstart Registration
Student Address*

Street Address

Street Address Line 2

CityState

Zip Code
Number of Students*
- Student Name*
  
  First NameLast Name
- Preferred Name
- Birth Date*
  
  MonthDayYear
- Gender*
- Current School*
- School District
- Grade Fall 2026*
- Hispanic or Latino?*
  
  YesNo
- Race*
  
  AsianBlack or African AmericanWhiteAmerican Indian or Alaska NativeOtherNative Hawaiian or Other Pacific Islander
- Allergies
- Medications
- Are you interested in Fall Registration at Phoenix Academy*
- Phoenix Academy regularly updates the school website, brochures, and social media. We rarely use any names and we never use last names. We would very much like your permission to use your child's photo.*
  
  YES - You MAY use my child's picture.NO - I would rather you DID NOT use my child's picture.
- Phoenix Academy has specially trained therapy dogs who come to school and our students have the opportunity to read to them. The therapy dogs and the trainer work for 10-15 minutes with a student. I give permission for my child to read to the therapy dog at Phoenix Academy.*
  
  YES - My child MAY read to the therapy dog at Phoenix Academy.NO - My child MAY NOT read to the therapy dog at Phoenix Academy.
- Student Name*
  
  First NameLast Name
- Preferred Name
- Birth Date*
  
  MonthDayYear
- Gender*
- Current School*
- School District
- Grade Fall 2026*
- Hispanic or Latino?*
  
  YesNo
- Race*
  
  AsianBlack or African AmericanWhiteAmerican Indian or Alaska NativeOtherNative Hawaiian or Other Pacific Islander
- Allergies
- Medications
- Are you interested in Fall Registration at Phoenix Academy*
- Phoenix Academy regularly updates the school website, brochures, and social media. We rarely use any names and we never use last names. We would very much like your permission to use your child's photo.*
  
  YES - You MAY use my child's picture.NO - I would rather you did use my child's picture.
- Phoenix Academy has specially trained therapy dogs who come to school and our students have the opportunity to read to them. The therapy dogs and the trainer work for 10-15 minutes with a student. I give permission for my child to read to the therapy dog at Phoenix Academy.*
  
  YES - My child MAY read to the therapy dog at Phoenix Academy.NO - My child MAY NOT read to the therapy dog at Phoenix Academy.
- Name
  
  First NameLast Name
- Student Name*
  
  First NameLast Name
- Preferred Name
- Birth Date*
  
  MonthDayYear
- Gender*
- Current School*
- School District
- Grade Fall 2026*
- Hispanic or Latino?*
  
  YesNo
- Race*
  
  AsianBlack or African AmericanWhiteAmerican Indian or Alaska NativeOtherNative Hawaiian or Other Pacific Islander
- Allergies
- Medications
- Are you interested in Fall Registration at Phoenix Academy*
- Phoenix Academy regularly updates the school website, brochures, and social media. We rarely use any names and we never use last names. We would very much like your permission to use your child's photo.*
  
  YES - You MAY use my child's picture.NO - I would rather you did use my child's picture.
- Phoenix Academy has specially trained therapy dogs who come to school and our students have the opportunity to read to them. The therapy dogs and the trainer work for 10-15 minutes with a student. I give permission for my child to read to the therapy dog at Phoenix Academy.*
  
  YES - My child MAY read to the therapy dog at Phoenix Academy.NO - My child MAY NOT read to the therapy dog at Phoenix Academy.
- Student Name*
  
  First NameLast Name
- Preferred Name
- Birth Date*
  
  MonthDayYear
- Gender*
- Current School*
- School District
- Grade Fall 2026*
- Hispanic or Latino?*
  
  YesNo
- Race*
  
  AsianBlack or African AmericanWhiteAmerican Indian or Alaska NativeOtherNative Hawaiian or Other Pacific Islander
- Allergies
- Medications
- Are you interested in Fall Registration at Phoenix Academy*
- Phoenix Academy regularly updates the school website, brochures, and social media. We rarely use any names and we never use last names. We would very much like your permission to use your child's photo.*
  
  YES - You MAY use my child's picture.NO - I would rather you did use my child's picture.
- Phoenix Academy has specially trained therapy dogs who come to school and our students have the opportunity to read to them. The therapy dogs and the trainer work for 10-15 minutes with a student. I give permission for my child to read to the therapy dog at Phoenix Academy.*
  
  YES - My child MAY read to the therapy dog at Phoenix Academy.NO - My child MAY NOT read to the therapy dog at Phoenix Academy.
- Student Contact Information
- Full Name*
  
  First NameLast Name
- Relationship*
- Email*
- Primary Phone Number*
  Format: 000-000-0000.
- Primary Phone Type*
- Alternate Phone Number
  Format: 000-000-0000.
- 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
  Format: 000-000-0000.
- Primary Phone Type
- Alternate Phone Number
  Format: 000-000-0000.
- 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*
  Format: 000-000-0000.
- Phone Type*
- Email
  example@example.com
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Comments or Questions
- Registration Fee
- Are you interested in Financial Aid?
- What prompted you to register for Summer Kickstart?*
- Tuition
  
  Please complete your registration by submitting the $100 per student registration fee or $750 per student tuition payment to Phoenix Academy.
  
  All tuition balances are due on or before July 7th, 2025.
- Payment Option*
  
  Credit Card/PayPalCheck
- Tuition
- Registration Fee/Tuition Payment
  
  prevnext( X )
  USDTuition
- 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.
- Type a question
- Payment Methods
  
  Choose from one of the PayPal options to make your payment.
- Should be Empty:

Summer Kickstart Registration