Admissions Application form Step 1 of 4 25% How many children are applying?*123456Program Selection:*Surf and Science AcademyAcademic OnlySurf Program Only #1 Child's Name*#1 Date of Birth* Date Format: MM slash DD slash YYYY #1 In which grade is your child?TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/Aprevious school (*note: student may stay enrolled in a public district, public charter or private school and attend Seashore as a supplemental or full-time program)#1 Days desired at Campus?*Write down on which days (Monday, Tuesday, Wednesday, Thursday, Friday) are you registering for at each Campus.#2 Child's Name*#2 Date of Birth* Date Format: MM slash DD slash YYYY #2 In which grade is your child?TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/Aprevious school (*note: student may stay enrolled in a public district, public charter or private school and attend Seashore as a supplemental or full-time program)#2 Days desired at Campus?*Write down on which days (Monday, Tuesday, Wednesday, Thursday, Friday) are you registering for at each Campus.#3 Child's Name*#3 Date of Birth* Date Format: MM slash DD slash YYYY #3 In which grade is your child?*TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/Aprevious school (*note: student may stay enrolled in a public district, public charter or private school and attend Seashore as a supplemental or full-time program)#3 Days desired at Campus?*Write down on which days (Monday, Tuesday, Wednesday, Thursday, Friday) are you registering for at each Campus.#4 Child's Name*#4 Date of Birth* Date Format: MM slash DD slash YYYY #4 In which grade is your child?*TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/Aprevious school (*note: student may stay enrolled in a public district, public charter or private school and attend Seashore as a supplemental or full-time program)#4 Days desired at Campus?*Write down on which days (Monday, Tuesday, Wednesday, Thursday, Friday) are you registering for at each Campus.#5 Child's Name*#5 Date of Birth* Date Format: MM slash DD slash YYYY #5 In which grade is your child?*TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/Aprevious school (*note: student may stay enrolled in a public district, public charter or private school and attend Seashore as a supplemental or full-time program)#5 Days desired at Campus?*Write down on which days (Monday, Tuesday, Wednesday, Thursday, Friday) are you registering for at each Campus.#6 Child's Name*#6 Date of Birth* Date Format: MM slash DD slash YYYY #6 In which grade is your child?*TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/Aprevious school (*note: student may stay enrolled in a public district, public charter or private school and attend Seashore as a supplemental or full-time program)#6 Days desired at Campus?*Write down on which days (Monday, Tuesday, Wednesday, Thursday, Friday) are you registering for at each Campus. Name of Primary Parent*Email of Primary Parent:* Cell Phone of Primary Parent*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Second ParentEmail of Second Parent: Cell Phone of Second ParentBy this electronic signature below, I agree to pay the non-refundable registration fee of $185*Per child/per programThe reasons why is family interested in applying to Seashore:* Surf & Science Academy Price: $370.00 Surf Program Price: $185.00 Academic Program Price: $185.00 Total $0.00 Pay with your credit card (Stripe)* Card Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged. A partnership of Seashore Academy and Little Surf Co.
