ACCK SUMMERBRIDGE REGISTRATION FORM 2018-100

ALGEBRA CLUB - COOL KIDS ACADEMICS (ACCKA) SUMMER BRIDGE PROGRAM REGISTRATION/WEEKLY PAYMENT FORM 2019

- An Academic / Recreational Summer Bridge Program for 2019 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 10th to July 25th - 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
Early Bird by June 1st $100 / $110 Weekly After June 1st

ALL FEES MUST BE PAID IN ADVANCE INCLUDING EXTENDED CARE

NO REFUNDS!!!

NO TRANSFER OR SUBSITUTIONS

OF WEEK(S) ONCE PROGRAM STARTS

ON JUNE 10TH, 2019
Non-Refundable Registration Fee: $50 per student.
CHECK FOR SPANISH IMMERSION PROGRAM

SPANISH IMMERSION ONLY FOR TK-1ST GRADE
THE ALGEBRA CLUB
Student Information (One Student) Please Complete if registering One Student.
Number of Students *
Last Name1 *
First Name1 *
Exiting Grade1 *
School Last Attended1
Principals Name
Email Address
Age1 *
Gender1 *
ACCKA Tee Shirt Size1 *
Week 1: June 10-13 Week 2: June 17-20 Week 3: June 24-27 Week 4: July 1-4

Week 5: July 8-11 Week 6: July 15-18 Week 7: July 22 -25 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 THURSDAY-JULY 4TH IN OBSERVANCE OF THE HOLIDAY .
Guardian Information
First Name *
Last Name *
Billing Address *
City *
State *
Zip Code *
Relationship *
Guardian"s" E-mail Address *
Phone Number *
Cell Phone Number
Work Phone
How Did You Hear About The Program.
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
ACCKA Tee Shirt Size2
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
ACCKA Tee Shirt Size3
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
ACCKA Tee Shirt Size4
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!

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 $ 110.00

Student 1 Week 2 Fee $ 110.00

Student 1 Week 3 Fee $ 110.00

Student 1 Week 4 Fee $ 110.00

Student 1 Week 5 Fee $ 110.00

Student 1 Week 6 Fee $ 110.00

Student 1 Week 7 Fee $ 110.00

Extended Care Child 1 Week 1 $ 25.00

Extended Care Child 1 Week 2 $ 25.00

Extended Care Child 1 Week 3 $ 25.00

Extended Care Child 1 Week 4 $ 25.00

Extended Care Child 1 Week 5 $ 25.00

Extended Care Child 1 Week 6 $ 25.00

Extended Care Child 1 Week 7 $ 25.00

Student 2 Week 1 Fee $ 110.00

Student 2 Week 2 Fee $ 110.00

Student 2 Week 3 Fee $ 110.00

Student 2 Week 4 Fee $ 110.00

Student 2 Week 5 Fee $ 110.00

Student 2 Week 6 Fee $ 110.00

Student 2 Week 7 Fee $ 110.00

Extended Care Child 2 Week 1 $ 25.00

Extended Care Child 2 Week 2 $ 25.00

Extended Care Child 2 Week 3 $ 25.00

Extended Care Child 2 Week 4 $ 25.00

Extended Care Child 2 Week 5 $ 25.00

Extended Care Child 2 Week 6 $ 25.00

Extended Care Child 2 Week 7 $ 25.00

Student 3 Week 1 Fee $ 110.00

Student 3 Week 2 Fee $ 110.00

Student 3 Week 3 Fee $ 110.00

Student 3 Week 4 Fee $ 110.00

Student 3 Week 5 Fee $ 110.00

Student 3 Week 6 Fee $ 110.00

Student 3 Week 7 Fee $ 110.00

Extended Care Child 3 Week 1 $ 25.00

Extended Care Child 3 Week 2 $ 25.00

Extended Care Child 3 Week 3 $ 25.00

Extended Care Child 3 Week 4 $ 25.00

Extended Care Child 3 Week 5 $ 25.00

Extended Care Child 3 Week 6 $ 25.00

Extended Care Child 3 Week 7 $ 25.00

Student 4 Week 1 Fee $ 110.00

Student 4 Week 2 Fee $ 110.00

Student 4 Week 3 Fee $ 110.00

Student 4 Week 4 Fee $ 110.00

Student 4 Week 5 Fee $ 110.00

Student 4 Week 6 Fee $ 110.00

Student 4 Week 7 Fee $ 110.00

Extended Care Child 4 Week 1 $ 25.00

Extended Care Child 4 Week 2 $ 25.00

Extended Care Child 4 Week 3 $ 25.00

Extended Care Child 4 Week 4 $ 25.00

Extended Care Child 4 Week 5 $ 25.00

Extended Care Child 4 Week 6 $ 25.00

Extended Care Child 4 Week 7 $ 25.00
For Additional Payment Options Available. Please contact Administrator algebraclubcoolkids1@gmail.com

747-200-5752
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