Little Ivy Academy LLC Online Registration

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

INSTRUCTIONS: Please select the Learning Enrichment Lab(s) and Summer Crossroads summer camp program(s) for which you are enrolling your child. You may select up to five (5) programs per child and register as many as five (5) of your children with this one registration form. Your registration will be confirmed via e-mail. If you have a coupon, the amount will be applied after registration is complete.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

INSTRUCTIONS: Please select the Learning Enrichment Lab(s) and Summer Crossroads summer camp program(s) for which you are enrolling your child. You may select up to five (5) programs per child and register as many as five (5) of your children with this one registration form. Your registration will be confirmed via e-mail. If you have a coupon, the amount will be applied after registration is complete.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

INSTRUCTIONS: Please select the Learning Enrichment Lab(s) and Summer Crossroads summer camp program(s) for which you are enrolling your child. You may select up to five (5) programs per child and register as many as five (5) of your children with this one registration form. Your registration will be confirmed via e-mail. If you have a coupon, the amount will be applied after registration is complete.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

INSTRUCTIONS: Please select the Learning Enrichment Lab(s) and Summer Crossroads summer camp program(s) for which you are enrolling your child. You may select up to five (5) programs per child and register as many as five (5) of your children with this one registration form. Your registration will be confirmed via e-mail. If you have a coupon, the amount will be applied after registration is complete.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies*

Medications (Leave blank if NONE)

Primary Doctor

INSTRUCTIONS: Please select the Learning Enrichment Lab(s) and Summer Crossroads summer camp program(s) for which you are enrolling your child. You may select up to five (5) programs per child and register as many as five (5) of your children with this one registration form. Your registration will be confirmed via e-mail. If you have a coupon, the amount will be applied after registration is complete.

Enroll in Classes

Select Class *

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies

(Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)