Academic Academy Form

Summer Academic Academy

Class of 2028 registered students

Student First Name*

Student Last Name*

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email*

Parent/Guardian Phone* - -

Address*

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Emergency Contact (other than parent/guardian)
First Name*

Emergency Contact Last Name*

Relationship to Child

Emergency Contact Phone* - -

Will your student attend all 5 days of the Academic Academy?*

Which day(s) will be missed?*

Photo Release*

I hereby give permission for images of my child, captured during the St. Paul Academic Academy 2024 through video or photos to be used solely for the purposes of St. Paul's promotional material and publications.

Signature*

Amount$100.00

I would like to pay for the credit card processing fees.

Subtotal: $

Fees: $

Grand Total: $

Payment Method:*

Payment Notes/Additional Info:

Name on Card:*

Email You Want Associated with Credit Card Payment:*

Credit or debit card*