The Learning Center Summer Program 2024

Contact Information
Child Name*

First NameLast Name
Currently Attending TLS?*

YesNo
Name of School*
URL
Shirt Size*
Child's Age*
Date of Birth*

MonthDayYear
Date
Grade for 2024-25 School Year
Does your child have an identified learning difference? If yes, explain. (A learning difference is not required for participation in the program)*
Parent / Guardian #1 Details*

First NameLast Name
Relationship to Student*

ParentGrandparentGuardian
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Parent / Guardian #2 Details

First NameLast Name
Relationship to Student

ParentGrandparentGuardian
Email
example@example.com
Phone Number
Please enter a valid phone number.
Authorized Car Pickup #1

First NameLast Name
Authorized Car Pickup #1 Phone Number
Please enter a valid phone number.
Authorized Car Pickup #2

First NameLast Name
Authorized Car Pickup #2 Phone Number
Please enter a valid phone number.
Project Code
256022 TLC Summer Program

Immunization
I understand that in accordance with Kentucky immunization law (KRS 158.035), no child shall be eligible for entrance into The Lexington School programming without first presenting an Immunization Certificate from a duly licensed medical practitioner or facility in Kentucky stating all immunizations are current (out of state and international families should contact healthoffice@thelexingtonschool.org for more information). I understand that The Lexington School is required to comply with the Fayette County Board of Health Regulations No. 3, 902 KAR 2:060 and KRS 214.034 as they are related to the collection and maintenance of immunization and physical records. It is my responsibility to submit hard copies of all immunization updates to The Lexington School prior to the start of the summer program I am enrolling my child in.
Signature*

Clear
Date*

MonthDayYear
Date

Refund Policy
We try to accommodate families with scheduling conflicts that occur after submitting registration. Please notify Shama Hinard, TLC Summer Program Director, as soon as possible if your child is unable to attend the TLC Summer Program.

The Director of The Learning Center must be notified more than 60 days before the start of camp to receive a 90% refund. Notifications within 30-60 days of camp will receive a 50% refund. No refund for cancellations within 30 days from the start of camp or after camp has started.

Session One - June 17 - 28 $1,600Monday-Friday | 8:00 A.M.-12:00 P.M.| $1,600

$1,600.00

Session Two - July 8 -19 $1,600Monday - Friday| 8:00 A.M.-12:00 P.M. | $1,600

$1,600.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country