HAAH Academic Enrichment Application
Welcome to High Achievers Aim High Academic Enrichment Programs. This educational program is designed for children grades PreK-6th. All applicants are responsible for an enrollment fee plus first week tuition to secure space. Once application is received, our Program Director will send a follow up email with further direction. Additional funds will be required for Field Trips (if applicable). Before Care 630am-8am and After Care 4pm-630pm are available, additional fees apply. All fees are non-refundable.
Season of Program
Winter
Spring
Summer
Child Name 1
Gender
Male
Female
Please select
Age and D.O.B
Grade
School
T-Shirt Size
Extra Small
Small
Medium
Large
Extra Large
Child Name 2
Gender
Male
Female
Age and D.O.B
Grade
School
T-Shirt Size
Extra Small
Small
Medium
Large
Extra Large
Child Name 3
Gender
Male
Female
Age and D.O.B
Grade
School
T-Shirt Size
Extra Small
Small
Medium
Large
Extra Large
Child Name 4
Gender
Male
Female
Age and D.O.B
Grade
School
T-Shirt Size
Extra Small
Small
Medium
Large
Extra Large
Parent Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Is it ok to text?
Yes
No
Enrollment Full Time or Part Time
Full Time
Part Time
Private or Public Pay
Private
Public
Before Care (additional $50/week) and After Care (additional $75/week)
Before Care
After Care
Neither
When will your child begin?
Please list other adults authorized to pick up your child(ren): Name, Relationship and Phone Number
Will the Child(ren) need to take any medications during camp? (if so, please list, if more than one child, list by name)question
Does your child have any specific needs?
Emergency Contact Name and Number
Health Insurance Carrier, Name of policy holder, Identification Number and Group Number
How did you hear about High Achievers Aim High?
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Registration Fee
$
25.00
One time fee per family.
Quantity
First Week Tuition New High Achievers
$
175.00
Quantity
First Week Tuition Returning High Achievers
$
125.00
Quantity
First Week After Care
$
75.00
Quantity
Item subtotal:
$
0.00
First Week Before Care
$
50.00
Quantity
Total
$
0.00
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