Summer Enrichment Registration Form

Date Today

MonthDayYear
Date
Summer Enrichment

When: June 13th to June 28th

Time: 11am to 1pm (Saturday and/or Sunday or 2 hours a day)

Please complete a seperate form submission per child.
Student Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender
Age
Please list any allergies or medical conditions we should be aware of:

Parent/Guardian Information
Name of Father

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of Mother

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Session: Check preffered day or both days.

Saturday Enrichment

June 3 weeks

$100.00 Quantity

Sunday Enrichment

June 3 weeks

$100.00 Quantity

Enter coupon

Total

Payment Methods

Credit Card

Google Pay

I, as the parent/guardian, understand that participation in selected workshop activity/activities involve inherent risks, including potential injury. I voluntarily assume all risks on behalf of my child associated with this activity. I release Aim Academy and its representatives from any claims related to my child's participation at Aim Academy.
Agreement
Should be Empty: