Winners Circle XR Academy, Inc.                          After School/Summer Program Application
This is for the 3D Design & Code Middle School After School, Spring Break, or Summer Program
Email *
This application has 5 sections. The sections are, 1) Application, 2) Media Release, 3) Release of Liability, and 4) Thank You.
XR Game Jam Summer Camp
Kindly complete the form provided below and proceed to register via the accompanying link. Please note that there is a registration fee associated with this process. However, scholarships are available to eligible students.
If you are interested in your child participating, please fill out this form and submit it one week prior to the program starting.
Students name (First, Last) *
Parent's NAME (First, Last) *
Parent's Phone *
Student's Grade *
You will be receiving a Winners Circle T-Shirt.                                                                                                        What size would you like? *
Do you give your child permission to join the Winners Circle XR Academy, Inc after school OR summer program? *
Does your child walk home? *
Is your child a Multi Language Learner (MLL) student? *
Does your child have a learning disability? *
Are you willing to share any documents so we can make adjustments for your child's learning style?
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Any allergies? *
If so, please describe below
Electronic Signature *
EMERGENCY INFORMATION                                                In case of an emergency, who else can we contact. Please provide the following information below:          NAME:                                                                                      PHONE:                                                                  RELATIONSHIP: *
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