Private High School Student Registration

Student First Name:

Student Last Name:

Student email:

School:

Current Grade:

GPA:

Why are you interested:


Parent Name:
Parent Telephone:
Parent Email:
Verify Parent Email:

Two Emergency Contacts:

1st contact same as parent
or:
Name:
Tel:
2nd contact Name:
Tel:
Fluent in:
English:
Spanish:
T-Shirt Size:
Small:
Medium:
Large:
Science Teacher or Couselor Info:
Name:
telephone:
email:

Dear Parent:

Thank you for your interest in the Ignite Biotech Summer Program! By writing your email here:

you are confirming that you are the parent or legal guardian of and you are consenting to your child’s participation in the 2018 Ignite Biotech Summer Program to be held at Colegio San Ignacio from June 18 to June 29. You also agree to pay a non refundable enrollment fee of $150 and an additional $600 tuition fee due May 11th. Paid slots will be filled on a first-come, first-serve basis. If we do not receive the tuition payment of $600 by May 11th, your child will be withdrawn from the program. The $150 enrollment fee will not be returned. When you click submit, you will be redirected to a page that will allow you to make your payment.