Registration

  • Student Information

  • Student Address
  • Please list above any allergies and medical conditions that the Academy needs to know about your child. Please include information about observable symptoms and reactions as they relate to any allergies or other conditions. If none, please write "none".
  • Parent/Guardian 1

  • If none, write "none."
  • If none, write "none."
    If not authorized, leave blank.
  • Parent/Guardian 2

  • If different than parent/guardian 1.
  • If none, write "none."
  • If none, write "none."
    If not authorized, leave blank.
  • Emergency Contact 1- When Parent/Guardians Cannot be Reached

  • If none, write "none."
  • If none, write "none."
    If not authorized, leave blank.
  • Emergency Contact 2- When Parent/Guardians Cannot be Reached

  • If none, write "none."
  • If none, write "none."
    If not authorized, leave blank.
  • Please briefly explain how your learned about our summer program.
    In the event of a medical emergency, every effort will be made to contact parent(s)/guardian(s) and emergency contacts listed above. In the event that these individuals cannot be reached, I authorize the Academy staff to reasonably act on my behalf to seek appropriate medical care for my child.
    The Academy will provide two (2) snacks each day to students (approximately 10:00am and 3:00pm). An Academy snack schedule will be made available if requested and will include items such as crackers, popcorn, yogurt, apple sauce, etc. Students must bring a sack lunch to class daily. No refridgerator or microwave will be available for student use, so please pack accordingly.
    Academy students must be picked up by 4:00 pm daily. No staff will be available for student supervision past 4:10 pm. Students picked up after 4:10 pm may incur a $1/minute charge for every minute past 4:10 that they are picked up.
    Cancellations must be made in writing and can be submitted in person, by email, or by fax. Cancellations must be submitted by 5:00 pm on the Thursday before the scheduled session to receive a full tuition refund. No refunds will be given for any cancellations submitted after the refund deadline. There are no refunds or credits for absence, illness, or vacations during the Summer Program. Registration fees are non-refundable.
    Though no cancellations are anticipated, the Academy reserves the right to cancel any session due to low enrollment. In the unlikely event of Academy cancellation, enrolled families will be notified by email no later than 5:00pm on the Thursday before the session is scheduled to begin. A full refund will be issued for any session(s) cancelled by the Academy.
    Tuition is $200 per week per student. A discount of 10% is available for enrollment of 3 weeks or more and 5% (for the second, third, and subsequent child) for multi-child enrollment.

    A one-time registration fee of $30 per child is due with the initial session's tuition.

    Tuition and registration fee can be paid by credit card on the ALI website: http://www.AZLearningInst.org, by telephone at 602-559-9799 (option 2), or in person at the program location.

    Cash or money orders can also be accepted at the program location.

    Tuition payment is due every week by the Thursday before the first day of session. A penalty of $20 may be assessed for late payment. Students will be unable to attend until the account is brought current.
    For consideration which is hereby deemed sufficient, I understand and agree to the following terms and conditions that include, but are not limed to, allowing Arizona Learning Institute (ALI) to use my or my minor chid(ren)'s story, picture, likeness, and/or video on its website, in emails, and for other promotional purposes.

    I hereby irrevocably grant in perpetuity to ALI, its legal representatives or assigns, affiliates and those acting under its permission and upon its authority, or those for whom ALI is acting, the absolute right and permission to:

    (a) copyright, use, re-use, and republish, and to license the right to use, re-use, publish, and republish my or my minor children's likeness and/or voice on film or videotape, to edit or change or alter such recording(s) at its sole discretion in which I or my minor children may be included in whole or in part to composite or distorted in character or form, in any medium or form of distribution without restriction as to changes or transformations in conjunction with real or fictitious name, or reproductions hereof in color or otherwise, made through any and all media now or hereafter known for any purposes whatsoever, including without limitation, illustration, art, promotion, advertising or trade;

    (b) copyright, use, re-use, publish and republish, and to license the right to use, re-use, publish and republish my or my minor children's likeness and/or voice on film or videotape, to edit or change or alter such recording(s) at its sole discretion in which I or my minor children may be included in whole or in part, or composite or distorted in character or form, in any medium or form of distribution without registration as to changes or transformations in conjunction with real or fictitious names, or reproductions hereof in color or otherwise, made through any and all media now or hereafter known for any purposes whatsoever, including, without limitation, illustration, art, promotion, advertising or trade; and/or

    (c) copyright, re-use, publish and republish, and to license the right to use, re-use, publish and republish my or my minor children's testimonial and edit such testimonial and its sole discretion, in any medium or form of distribution without restriction as to changes or transformation in conjunction with real, fictitious names, made through any and all media now and hereafter known for any purposes whatsoever, including, without elimination, illustration, art, promotion, advertising or trade.

    It is my understanding that I will receive no compensation for my or my minor children's likeness or testimonial.

    I hereby waive any right that I may have to inspect and/or approve the finished product or the advertising copy or printed matter that may be used in connection with my or my minor children's likeness or testimonial or the use to which it may be applied. I agree that I have no rights to the photographs, reproductions, negatives, videos or films, and all rights to such materials belong to ALI.]]I hereby release, discharge and agree to save harmless ALI and its employees or agents, affiliates, legal representatives or assigns and all persons acting under its permission or upon its authority or form whom it is acting, from any liability by virtue of any publication of my or my minor children's likeness or testimonial, including, without limitation, claims for libel or invasion of privacy, as well as any liability arising by virtue of any blurring, distortion, alteration, optical illusion of use in composite form, whether intentional or otherwise, that may occur or be produced in the making of such picture or recording(s) or in any processing tending towards the completion of the finished product.

    I hereby warrant that I am of full age and have every right to contract in my own name and for my minor children in the above regard. I state further that I have read the above authorization and release prior to its execution, and that I am fully familiar with the contents thereof. This agreement shall be biding upon me and my heirs, legal representatives and assigns.

  • Please sign this document by typing your initials above. The signing party agrees that this electronic signature shall be as effective as any other signature. It is further represented that the signing party intends for this electronic signature to be his/her signature.

    **Please note that an in-person signature will be required on the first day of the first session the child attends.