🎭 HOME CONFIDENCE & ENRICHMENT ACADEMY

Summer Program Registration (Ages 8–11)

📍 Home Christian Church | June 1 – August 14

✨ Enrollment Information

Thank you for your interest in the Home Confidence & Enrichment Academy!

This is a structured, full-day enrichment program focused on confidence, academics, creative expression, and fun in a small-group environment.

⚠️ Enrollment is limited to 25 students

Spots are secured upon completion of registration and payment.

👤 STUDENT INFORMATION

Child's Full Name:

Birthday

Month

Day

Year

Child's Age:

👨‍👩‍👧 PARENT / GUARDIAN INFORMATION

First name

Last name

Email Address

Phone Number

Emergency Contact Name:

Emergency Contact Phone

🏥 MEDICAL & SAFETY INFORMATION

Does your child have any allergies?

No

Yes

If yes, please explain.

Any medical conditions we should be aware of?

Any behavioral or learning needs we should know?

📅 ENROLLMENT SELECTION

Please select the weeks you are registering for:

💰 PAYMENT OPTION

Please select your preferred payment method:

Weekly ($200/week)

Monthly ($750/month – Best Value)

Full Summer (Discounted Rate)

💳 PAYMENT POLICY AGREEMENT

Please read and acknowledge:

A $40 non-refundable registration fee is required to reserve your child’s spot
Weekly tuition is $200 and must be paid in advance
First week’s tuition is due one week prior to start date
Future payments are due each Friday before the upcoming week
Spots are not guaranteed without payment
No refunds for missed days

I understand and agree to the payment policy.

📜 PROGRAM EXPECTATIONS

To maintain a positive environment:

Students are expected to participate respectfully
Disruptive behavior may result in dismissal from the program
Parents will be notified of any concerns

I understand and agree to program expectations

📸 PHOTO / VIDEO RELEASE

We may capture photos/videos for program highlights and promotional use.

Yes, I give permission

No, I do not give permission

Registration Fee

$0

✍️ SIGNATURE

Parent/Guardian Name:

Parent/Guardian Signature

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First Week Tuition Due May 25

Pay Your First Week (optional before May 25)$200

Today's Date: