TES Summer Program Registration Form

TES' Academic's 2021 Registration Form

Please complete each section of the application to register your child/children for Teaching Empowering Strengthening's (TES) Remote Reading Enrichment Program. Sessions will take place six hours a week beginning March 8th and ending August 21st. The $80 registration fee is due March 8, 2021.
Child(ren)'s Information
Child/Children's Full Name *
please include all children you want to register
Child/children's Date of Birth *
ie. David - 12/15/10
Child/children's Grade *
ie. David - 4th grade
School Child/children Attends *
ie. David - Betty Shabazz International Charter School
Does your child/children have any dietary restrictions? *
Please provide information on any medication, chronic physical problems and pertinent developmental information and any special accommodations needed. *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent/Guardian Information
Name *

First Name Last Name
Relationship *
Cell Phone Number *

Area Code Phone Number
E-mail *
Best form of contact

Text Email Call
Emergency Information
Relationship
Phone Number *

Area Code Phone Number
Alt. Phone Number

Area Code Phone Number
I individually as a parent/guardian of the child identified above hereby agree to the following:
*

I understand and agree that I will not receive any refund for missed sessions. I confirm that I have fully disclosed to TES any and all conditions (whether physical, mental or behavioural or otherwise) that my child has or may have before my child participates in the program.. I allow my child to be photographed (for marketing purposes) throughout the TES program.
You can pay the registration fee with a credit or debit card by using the checkout below.
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Registration Fee $ 80.00
The payment is for student's materials, virtual placement test, and parent/student information session.

Total $ 0.00
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Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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TES' Academic's 2021 Registration Form