kidsacademy

Student Information

Student Name(Required)

First Last

Birth Date(Required)

Gender(Required)

Male

Female

Grade in Sept 2024(Required)

Does the student have a sibling registered or will register to Kids Academy or Youth Mentorship program this term?(Required)

Yes

No

Primary Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I have Registered my Kid last year(Required)

Yes – goes directly to payment

No

Parent / Guardian Information

Father Name(Required)

First Last

Father Phone(Required)

Father Email(Required)

Mother Name(Required)

First Last

Mother Phone(Required)

Mother Email(Required)

Emergency Contact Information

Please list a contact that is not listed on this form, to be used if Parent / Guardian cannot be reached

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Emergency Contact Email(Required)

Relationship to Student(Required)

Physician Info

Do you have a physician(Required)

Physician Name(Required)

First Last

Physician Phone(Required)

Any specific condition that we need to know about your kid?

Does your child have a Medical Condition.(Required)

Medical Info

I hereby state that my son/daughter whose name appears on the first page of this document under ‘Student Information’ has the following medical condition(s) that the BE&C staff should be aware of during the school. I hereby state that I have provided the necessary medication to the BE&C staff. I instructed them how to give the medication to my child if need arises, and give permission to administer the medication to my child. I hereby state that my son/daughter is otherwise in good physical health condition to participate in the activities provided by BE&C, including but not limited to all aspects of running, and folk dance training, basketball, soccer and or competition. I am fully aware that any activity involving motion, height or athletic activity creates the possibility of injury. I hereby state that I have provided the necessary medication to the BE&C staff. I instructed them how to give the medication to my child if need arises, and give permission to administer the medication to my child. I hereby state that my son/daughter is otherwise in good physical health condition to participate in the activities provided by BE&C, including but not limited to all aspects of running, and folk dance training, basketball, soccer and or competition. I am fully aware that any activity involving motion, height or athletic activity creates the possibility of injury.

Medical Condition 1

Required Medication for Condition 1

Medical Condition 2

Required Medication for Condition 2

Additional Medical Conditions and their Medication

Consent

Payment

The cost for this year’s weekend school program ranges from $1,250 to $1,500, with a minimum price of $1,250. We offer a 12.5% sibling discount for each additional sibling registered in the program. For families opting for financing, there are two payment options available: a two-payment plan, which adds $50 to the total cost, and a four-payment plan, which adds $100 to the total cost. Please note that the payment plans are based on the minimum payment of $1,250. For example, if the base price is $1,250, the two-payment option would bring the total to $1,300, while the four-payment option would bring it to $1,350. We highly encourage families to consider paying the full price of $1,500 if possible, as this would relieve us of financial stress and allow us to continue providing high-quality programs and services to the students. For further details, please contact us at finance@bostoneducation.us.

Payment Strategy(Required)