Academy application for ENGLISH

Application Form for English Enrichment Classes

2024/25 Year.
Use this form to register a participant for our Virtual or In-Studio English Enrichment Classes.

Once this form has been submitted, you will see a confirmation message on your screen and receive an email confirming the form has been received. Please complete a new form for each participant
Date

MonthDayYear
Date
STUDENT INFORMATION
Have you been to Centauri Before?

YESNO
Full Name of Student*

First NameLast Name
If your child goes by a different name other than their given name above, please specify here:
Date of Birth (if under 18)
MM/DD/YYYY
Grade
Name of school at which the student is registered
Student Cell Number (if they have one)
Student Email*
CONTACT INFORMATION
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number*
Family Email*
GUARDIAN CONTACT INFORMATION
(if participant is under 18)
Guardian 1 Full Name*

First NameLast Name
Relationship to Participant*
Guardian 1 Email*
Guardian 1 Cell Number*
Guardian 2 Full Name

First NameLast Name
Relationship to Participant
Guardian 2 Email
Guardian 2 Cell Number
Please outline any specific academic challenges faced by the student – for example, essay structure, grammar, reading comprehension.
If your child has an IEP, or specific identified learning needs, please give details here
Please note any concerns related to your child’s physical or mental health of which we should be aware. If your child has any identified barriers to learning (such as low self confidence, or poor organisational skills), please note them here.
NEW STUDENTS: We offer a 45 minute private assessment session prior to the start of your first class in order to ensure you are placed in the most appropriate group. Assessments take place virtually, and are offered free of charge. If you have not already completed an assessment, we will be in touch to arrange one as soon as this form is received.
We are now booking multiple time slots throughout the week for our English Enrichment Program. Please call us at 416 766 7124 to schedule a time for your student.
Please specify if you would prefer Virtual or In-Studio Classes

VirtualIn-Studio (Toronto)
There is a minimum enrollment period of 3 months for this academic program. All families will be billed at the start of each 4 week period. The deposit of $300 is the first 4 week payment.
Booking Code
Payment option

I will pay first 4 weeks now and be billed for each subsequent block of 4 weeks.I will pay for the full 12 weeks now.
Total
HST (13% tax)
Grand Total
Payment Method*

I will pay now online (credit card)I will call with a credit cardI will send an e-transfer
Credit Card Payment

prevnext( X )
CADDescription
Where did you find out about Centauri Arts Academy*

Web Search - Goolgle/BingReferral from a family memberReferral from a friend (please give the name in the comments)TwitterFacebookSaw our sign in Bloor West VillageNewspaper/MagazineOther
Comments
I authorize my son/daughter to leave at the end of the course(s) unescorted (for in studio courses only) *
Please write the names of all adults authorized to collect the participant at the end of the course
Please read:
Virtual class booking conditions
Virtual class code of conduct for participants

In Studio Class booking conditions
I have read, understand and agree to the booking conditions *

YES
Name of person completing the form
Please add me to your email list to receive communications about news and events
QUESTIONS? Call 416 766 7124 CONFIDENTIALITY OF INFORMATION: Information collected on this form will be used for Centauri Summer Camp Inc and Centauri Arts. purposes only Information will be used to process your enquiry and to send you future information either by electronic means or mail. We will not pass information onto any 3rd parties unless agreed by you in advance. If you wish to be removed from our lists, please contact us and we will remove your information. Go to http://www.centauriartscamp.com/about/privacy-policy/ to see our full privacy policy.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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Application Form for English Enrichment Classes