Estuary Immersion Spring 2025 Registration- FRIDAYS 10-2

Parent Name *

First

Last

Child 1 *

First

Last

Child 1 Birthdate *

Child 2 (if applicable)

First

Last

Child 2 Birthdate

Child 3 (if applicable)

First

Last

Child 3 Birthdate

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Please let us know about any developmental concerns:

enrichment Square know

Please let us know about any allergies: *

If you intend to pay partial fees with your $300/per semester enrichment funding, which Distance Education School are you working with? *

Up to $300 per semester may be covered by your school (The Grove, NIDES, Fawkes Academy, Oak + Orca etc) You are responsible for any fees not covered by your home learning program.

Payment Options *

Pay Now, in Full, $650 – $650.00
Pay Deposit Only – $250.00
Pay difference of $300 Distance Ed School Distributed Learning Funding – $350.00
Please contct me to make payment arrangements – $0.00

(Please note that the price increase is due to 3 extra weeks of programing! The fall cohort was 12 weeks, and the spring cohort will be 15 weeks!)

Square *

Card

Name on Card