ALGEBRA CLUB - COOL KIDS ACADEMICS (ACCKA) SUMMER BRIDGE PROGRAM REGISTRATION FORM 2018
An Academic / Recreational Summer Bridge Program for 2018
Keep your child academically stimulated with FUNdamentals all summer long!
Summer Bridge is designed for students In Transitional Kindergarten through 9th grade.
Summer school academics and recreation sports throughout the day!
Academics/Recreation June 11th to July 26th - Monday - Thursday
Optional field trips on Fridays
(Before & after care if needed)
7:00 AM to 6:00 PM
Free Breakfast and Lunch! * FEES: $100 Weekly
CHECK FOR SPANISH IMMERSION PROGRAM
SPANISH IMMERSION ONLY FOR TK-1ST GRADE
THE ALGEBRA CLUB
Non-Refundable Registration Fee: $50. per student.
Student Information
(One Student) Please Complete if registering One Student.
Number of Students
*
Please Select
1
2
3
4
xxxxx
xxxxxx
Last Name1
*
First Name1
*
Exiting Grade1
*
School Last Attended1
Principals Name
Email Address
Age1
*
Gender1
*
Please Select
Male
Female
ACCKA Tee Shirt Size1
*
Please Select
Youth Size Small
Youth Size Medium
Youth Size Large
Adult Size Small
Adult Size Medium
Adult Size Large
Adult Size XX
Week 1: June 11-14
Week 2: June 18-21
Week 3: June 25-28
Week 4: July 2-5
Week 5: July 9-12
Week 6: July 16-19
Week 7: July 23 -26
PLEASE SCROLL TO THE BOTTOM OF THE PAGE
TO MY PRODUCTS
AND SELECT THE REGISTRATION FOR THE NUMBER OF STUDENTS BEING REGISTERED AND THE WEEKS YOU ARE PAYING FOR ON ALL STUDENTS AND THEN
PROCEED TO CHECK OUT
!
Additional Weekly Payment Options Available contact: (747) 200-5752 or algebraclubcoolkids1@gmail.com for more information
ATTENTION: WE WILL BE CLOSED WEDNESDAY-JULY 4TH IN OBSERVANCE OF THE HOLIDAY
.
Guardian Information
First Name
*
Last Name
*
Billing Address
*
City
*
State
*
Zip Code
*
Relationship
*
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Foster Parent
Other
Guardian"s" E-mail Address
*
Phone Number
*
Cell Phone Number
Work Phone
How Did You Hear About The Program.
Please Select
Friend
School Site
Flyer
Neighbor
Relative
THE ALGEBRA CLUB
Non-Refundable Registration Fee: $50. per student.
Student Information
(Two Students) Please Complete if registering Two Students.
Last Name2
First Name2
Exiting Grade2
School Last Attended2
Principals Name
Email Address
Age2
Gender2
Please Select
Male
Female
ACCKA Tee Shirt Size2
Please Select
Youth Size Small
Youth Size Medium
Youth Size Large
Adult Size Small
Adult Size Medium
Adult Size Large
Adult Size XX
Student Information
(Three Students) Please Complete if registering Three Students.
Last Name3
First Name3
Exiting Grade3
School Last Attended3
Principals Name
Email Address
Age3
Gender3
Please Select
Male
Female
ACCKA Tee Shirt Size3
Please Select
Youth Size Small
Youth Size Medium
Youth Size Large
Adult Size Small
Adult Size Medium
Adult Size Large
Adult Size XX
THE ALGEBRA CLUB
Non-Refundable Registration Fee: $50. per student.
Student Information
(Four Students) Please Complete if registering Four Students.
Last Name4
First Name4
Exiting Grade4
School Last Attended4
Principals Name
Email Address
Gender4
Please Select
Male
Female
ACCKA Tee Shirt Size4
Please Select
Youth Size Small
Youth Size Medium
Youth Size Large
Adult Size Small
Adult Size Medium
Adult Size Large
Adult Size XX
My Products - Please Select the Correct Number of Students that are being Registered Today! Select the Weeks you want to Pay for each Student! PROCEED TO CHECK OUT!
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Non-Refundable Registration Fee 1 Student
$
50.00
Non-Refundable Registration Fee 2 Students
$
100.00
Non-Refundable Registration Fee 3 Students
$
150.00
Non-Refundable Registration Fee 4 Students
$
200.00
Student 1 Week 1 Fee
$
100.00
Student 1 Week 2 Fee
$
100.00
Student 1 Week 3 Fee
$
100.00
Student 1 Week 4 Fee
$
100.00
Student 1 Week 5 Fee
$
100.00
Student 1 Week 6 Fee
$
100.00
Student 1 Week 7 Fee
$
100.00
Student 2 Week 1 Fee
$
100.00
Student 2 Week 2 Fee
$
100.00
Student 2 Week 3 Fee
$
100.00
Student 2 Week 4 Fee
$
100.00
Student 2 Week 5 Fee
$
100.00
Student 2 Week 6 Fee
$
100.00
Student 2 Week 7 Fee
$
100.00
Student 3 Week 1 Fee
$
100.00
Student 3 Week 2 Fee
$
100.00
Student 3 Week 3 Fee
$
100.00
Student 3 Week 4 Fee
$
100.00
Student 3 Week 5 Fee
$
100.00
Student 3 Week 6 Fee
$
100.00
Student 3 Week 7 Fee
$
100.00
Student 4 Week 1 Fee
$
100.00
Student 4 Week 2 Fee
$
100.00
Student 4 Week 3 Fee
$
100.00
Student 4 Week 4 Fee
$
100.00
Student 4 Week 5 Fee
$
100.00
Student 4 Week 6 Fee
$
100.00
Student 4 Week 7 Fee
$
100.00
For Additional Payment Options Available. Please contact
Administrator
algebraclubcoolkids1@gmail.com
747-200-5752
Proceed to Checkout
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