Summer Pod Registration 2023-24 Application

I am registering for Life Skills offered from 10 am-12 pm on Monday through Wednesday.

I understand the cost is $75.00 a week beginning every week.

All Classes are offered in the months of June and July~

The topics that will be taught each week include~

Basic Hiking Survival Skills/Basic Car Mechanics/Basic Gardening/Basic Archery

(Please list the weeks you would like to attend below)

June

Week #1 5-7

Week #2 12-14

Week #3 19-21

Week #4 26-28

July

Week #1 10-12

Week #2 17-19

Week #3 24-26

Week #4 31-2

I am registering for summer tutoring.

I understand it will be offered for Writing, Reading, and Math on Monday, Tuesday, and Wednesday between

12 pm-3:00 pm.

I understand the cost is $35.00 an hour, and I will pay the day service is offered.

Please list your specific subject(s), weekday(s) and time preference(s) below

Parent #1 Information-Full Name

Parent #1 Home Address

County of Residence

Parent -1 Phone Number

Parent -2 Information-Full Name

Parent -2 Home Address

Parent -2 Phone Number

Parent -2 Email

How did you hear about AIM ACADEMIC POD?

List most recent school attended

Are you a homeschooler? For how many years?

Student 1 - Full Name

Student 1 - Current Grade

Student 1 - Date of Birth

List allergies:

List any special needs or delays your child has (e.g., Down's syndrome, autism spectrum, sensory issues, learning disabilities, dyslexia, attention, behavioral, or social issues, speech/language deficits, hyperactivity, other). This information will be kept confidential.

Do you need to add more students?

Yes

No

Clear selection

Student 2 - Full Name

Student 2 - Current Grade

Student 2 - Current Age

Student 2 - Date of Birth

List any allergies:

List any special needs or delays your child has (e.g., Down's syndrome, autism spectrum, sensory issues, learning disabilities, dyslexia, attention, behavioral, or social issues, speech/language deficits, hyperactivity, other). This information will be kept confidential.

Do you need to add more students?

Yes

No

Clear selection

Student 3 - Full Name

Student 3 - Current Age

Student 3 - Date of Birth

List any allergies

List any special needs or delays your child has (e.g., Down's syndrome, autism spectrum, sensory issues, learning disabilities, dyslexia, attention, behavioral, or social issues, speech/language deficits, hyperactivity, other). This information will be kept confidential.

Do you need to add more students?

Yes

No

Clear selection

Student 4- Full Name

Student 4 - Current Age

Student 4 - Date of Birth

List any allergies

List any special needs or delays your child has (e.g., Down's syndrome, autism spectrum, sensory issues, learning disabilities, dyslexia, attention, behavioral, or social issues, speech/language deficits, hyperactivity, other). This information will be kept confidential.

List any additional information that would be relevant to the consideration of your application.

By checking the box below, I attest that all statements made on this application are accurate and complete. I understand that submitting false statements or withholding relevant information will result in the denial or dismissal of my application

I Agree