Starz Children Foundation, Inc Online Registration

Registration

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Hello, welcome to the 360AcademyTM summer online classes! 360AcademyTM is a tutoring service provided by Starz Children Foundation, Inc. (Starz/360Academy). Our subject tutoring program is aimed to enrich students' knowledge and assist them to excel academically. Students are expected to participate and engage in order to fully benefit from our programs. We've made online registration easy and convenient for you.

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Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Additional Info

Emergency Contact Name #1*

Emergency Contact Phone #1

Emergency Contact Name #2

Emergency Contact Phone #2

Contact #1

Parent/Guardian #1 First Name*

Last Name *

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Parent/Guardian #2 First Name

Last Name

How can we contact you?

Home Phone

Work #

Cell # *

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level in 2024 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Please click on the SELECT CLASS below, then choose the class.

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Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level in 2024 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Please click on the SELECT CLASS below, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level in 2024 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Please click on the SELECT CLASS below, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level in 2024 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Please click on the SELECT CLASS below, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level in 2024 School Year*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications

Please click on the SELECT CLASS below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

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

eCheck/Bank Draft

Required Policies

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