FUNdamental Minds Quarter 4 FUNday Elective Class Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Classes held Mondays from 10am-3pm and include Creative Writing, STEM, Animation, and Drama. $75/week, $60/week for siblings. Registration includes enrollment and all materials for all four elective classes. Note: no electives on 3/11 (Spring Break).

Zephyrhills Address: 35008 SR-54

Phone Number: (813) 409-3110

Email: director@fundamentalminds.com

Please complete one form for each child attending.

Email *

What is your name?
*

What is your phone number?
*

What is your child's name? *

What age group is your child in?
*

5-7

8-10

11-13

Which week(s) will your child attend?
*

Week 1- 3/4

Week 2- 3/18

Week 3- 3/25

Week 4- 4/1

Week 5- 4/8

Week 6- 4/15

Week 7- 4/22

Week 8- 4/29

Week 9- 5/6

Week 10- 5/13

Week 11- 5/20

Required

The regular hours for Elective days are from 10am-3pm. We do offer optional before/aftercare that allows for student drop-off as early as 6:30am and pick-up until 5:30pm for an additional $25. Will you need before/aftercare services?
*

Yes

Is your child fully potty trained, needing no bathroom support?
*

Yes

Does your child have any medical concerns or allergies we need to be made aware of? Please explain or write N/A.
*

Has your child been diagnosed with an emotional, physical, mental, or educational disability? If so, please state the diagnosis and any applicable supports needed for your child. If not, please write N/A.
*

Does your child require additional 1-on-1 support from an adult/aide in academic/social environments? Please describe below or write N/A if not applicable.
*

Are there any academic/behavioral concerns that we should be aware of (for example: resistance to writing, failure to follow directions when given, physical acts of aggression toward self or others)? Please describe below or write N/A if not applicable.
*

Do you qualify for any of the following discounts? (Proof of eligibility required)
*

Sibling (must be registered for the same day)

Military (active or retired)

First Responder (EMT, Fire, Police)

School Employee

None of the above

Required

I understand that payment is due upon successful registration and refunds will not be provided for any absences.
*

Yes

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Fundamental Minds. Report Abuse

Forms