BRAIN CAMP REGISTRATION

Please complete this form to register for Brain Camp. You will be contacted by our staff shortly. Thank you for your interest in Ridge Academy's Brain Camp.

Parent Full Name(s) Mother's Phone #'s Father's Phone #'s

Mother

Father  

home  

work  

cell     

page    

email    

 

home  

work  

cell     

page    

email    


Mother's Address City State Zip Code
Father's Address City State Zip Code

Child(ren) Name(s) Grade Level Birth Date

Our child(ren) are interested in attending Brain Camp
E M E R G E N C Y   C O N T A C T S Contact #1's Phone #'s Contact #3's Phone #'s

1.

2.  

3.  

home  

work  

cell     

Contact #2's Phone #'s
home    

work   

cell     

 

home  

work  

cell     


C A R  P O O L  / S T U D E N T  R E L E A S E   A U T H O R I Z A T I O N
I give my permission to release my child to the following individuals for dismissal pick up / car pool.
      1            2


Please list any medical conditions our staff should be aware of:

Our program requires and expects cooperative behavior which is conducive to learning.  Students who are disruptive to the learning environment will not be allowed to remain in our program, and no refunds will be given.

Ridge Academy does not discriminate on the basis of race, gender, color, religion, national origin, or ancestry.

 

 

  

 

 
 
Ridge Academy

Letter of Interest
.........................................
Mail

Ridge Academy
2501 West 103rd Street
Chicago, IL 60655
.........................................
Phone

(773)233-0033
.........................................
email

admissions@ridgeacademy.org
.........................................

 

 

 

 

 

 

 

  


Ridge Academy
2501 West 103rd Street
Chicago, IL 60655
(773)233-0033

email
kenkoll@ridgeacademy.org

 

Design: one stop desktop multimedia
and
Chadha and Associates
Host: ANET