Clone of Big Dreams Academy Registration

Summer Registration
Welcome to SUMMER FUN at Big Dreams Academy! We will be having lots of great activities for our first summer together! Our summer program will be July 8th - August 28th. Open 3 days a week, Wednesday-Friday, 8-4pm.
Student's Name*

First NameLast Name
Gender*
Birthday*

MonthDayYear
Date
Add a sibling
Student's Name

First NameLast Name
Birthday

MonthDayYear
Date
Gender
Parent/Guardian*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
E-mail
example@example.com
Parent/Guardian #2

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Contact (besides a parent):*
Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
The following people (besides parents & emergency contact) have permission to pick up (also include anyone NOT allowed):
If any of the above list changes through the year please send message the office number at least 24 hours before pick up.
Child Medical Provider & Doctor Name
Health Insurance Provider
Health Insurance Policy Number
List of any allergies and/or medications (if taken during our hours):
Please list any special needs for your child academically, socially or behaviorally and what has or hasn't worked well in their past learning environments:
Anything else you would like Big Dreams Academy to know:
At Big Dreams! Academy we will always keep your children safe however we know accidents can happen. Throughout the summer we will be walking to the park, driving places for field trips (myself and other teachers), doing science experiments, art and cooking, etc so please mark below you agree to our liability release form:
Sign here to state you've read and agree to the Liability Release Form
Thank you for applying!

We are looking forward to having a fun filled summer!
Summer Payment Options*
prevnext( X )
July & August
$950.00 Number of kids



July
$500.00 Number of kids



August
$500.00 Number of kids



Total

$0.00

Payment Methods

Debit or Credit Card

Should be Empty:

Summer Registration