Bridgeway Registration Form

Bridgeway Registration Form

Poinciana, FL | (843) 481-5016
Student Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Subject In Need
Grade Level
Breakfast and Lunch is part of the tuition- do you approve?

YesNo- I will provide food for my child
Does your child have a laptop?

YesNo-
What is your biggest concern and your goal for your child? (areas of concern).
My Products
Categories:All

All
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Summer session- 4 week sessionIn person- June 1st- July 3rd
$300.00



Saturday classes- 3 hours Zoom or in person- (9AM-12PM)
$50.00



Summer Session- 6 weeks SessionIn person- June 1st- July 17th
$400.00



Total

$0.00
Parent/Guardian Signature
Date Signed

MonthDayYear
Date
Please read the following

The Summer session starts June 1st- July 3rd.

Parents are responsible for students drop off and pick up.

Please ensure that all kids are picked up at 3:30 PM the latest.

Students may come with their school's materials. (Laptops)

Your tuition covers- food, and materials they will need.
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty: