ACADEMIC SUMMER INTENSIVE ENROLLMENT FORM
Please fill out the following form to enroll your child in one or more Academic Summer Intensive Sessions. Please note that enrollment is not complete until payment is made in full. Courses are $795 per session. Please fill out one form for each child. For any questions, please contact Darci at darci@wvmiddleschool.com or 408-985-2138.
Sign in to Google to save your progress. Learn more
Parent's Name: *
Parent's Phone Number: *
Parent's Email Address: *
Child's Name: *
Grade Level child is completing in the 2020-21 School Year: *
What school does your child attend? Please note that if your child is not currently attending one of our ADPP locations, we will set up a Smartcare account for your billing using the email address provided and will email you any necessary forms that need to be filled out. *
Would you like to sign up for bussing to or from Amber? *
Required
Please select the courses you would like to enroll your child in for Session #1 (June 8th-June 25th, 8:30-11:30am, Tuesdays-Fridays)
Please select the courses you would like to enroll your child in for Session #2 (June 8th-June 25th, 1:30-4:30pm, Tuesdays-Fridays)
Please select the courses you would like to enroll your child in for Session #3 (June 29th-July 16th, 8:30-11:30am, Tuesdays-Fridays)
Please select the courses you would like to enroll your child in for Session #4 (June 29th-July 16th, 1:30-4:30pm, Tuesdays-Fridays)
Please select the courses you would like to enroll your child in for Session #5 (July 19th-August 5th, 8:30-11:30am, Mondays-Thursdays)
By checking the box below, I agree to all ADPP policies and procedures. I understand that my Smartcare account will be billed $795 per course and payment will need to be received in order for my child's enrollment in the Academic Summer Intensive is complete. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Action Day Schools. Report Abuse
Google Forms