Clone of CALI Center Summer Program

1
Child's Name* This field is required.
First Name
Last Name
2
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
United Kingdom
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Afghanistan
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Anguilla
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The Bahamas
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Dominican Republic
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Falkland Islands
Faroe Islands
Fiji
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France
French Polynesia
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Mali
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Mayotte
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Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
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Slovakia
Slovenia
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Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Child's E-mail Address* This field is required.An email account is necessary for coding. Write none, if you do not wish to make your child an email account.
4
Male/Female
Male
Female
5
Birth Date* This field is required.
Month
Day
Year
6
Student age* This field is required.
7
Grade in Sept 2026* This field is required.
8
Reading Level* This field is required.
On Level
Below Level
Unsure
9
Math Level* This field is required.
On Level
Below Level
Unsure
10
Explain more here if necessary
11
Does the student have an IEP?* This field is required.
Yes
No
12
If yes, Please tell us more
13
Please List Any Known Allergies* This field is required.(write NONE if no allergies)
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Ok
14
Please list the dates that your child will be at Cali Center.* This field is required.example: 7/8/24-8/16/24
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15
Please provide parent/guardian information.
16
Parent's Name* This field is required.
17
Parent's Email Address* This field is required.
18
Parent's Contact Number* This field is required.
19
Parent Signature* This field is required.
20
Terms and Conditions* This field is required.Please read the terms and conditions. Feel free to print for your records.
21
Summer Program* This field is required.Please complete a separate form for each child
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ORDER SUMMARY
Total costUSD
Summer Program (Full Payment)
6 weeks
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Summer Program (Full Payment)
6 weeks Sibling Discount
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Summer Program (Full Payment)
5 weeks
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Summer Program (Full Payment)
5 weeks (Sibling Discount)
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Summer Program (Full Payment)
4 Weeks
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1
2
SIBLING DISCOUNT
Summer Program (Full Payment)
4 Weeks Sibling Discount
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1
1
2
SIBLING DISCOUNT
Total cost
22
Invoice ID
23
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