Service & Payment Plan*

Pathways: Thursday

Price

$105.00

Guardian First Name*

Guardian Last Name*

Guardian Email*

Guardian Phone Number*

Student First Name*

Student Last Name*

Student Date of Birth*

Student Address*

School for 2026-2027

Grade for 2026-2027

Allergies/Medical Conditions*

Other pertinent info

Emergency Contact Name & Phone Number(s) (in the event guardian cannot be reached)*

By checking the below box, I state that I have read, understood, and agree to the linked Terms & Policies.*

Payment Information*

Payment amount:

$105.00

Total to pay:

$105.00