Dreams Academy · Summer Institute-Pay Later

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We are excited to present the Black Brilliance Summer Institute, June 17th to July 25th. Tuition for this Dreams and Queens Academy experience is $350. This cost helps us to cover fields trips, food, materials, and staffing. A deposit of $150 is due June 3rd to secure the students spot. If payment arrangements need to be made, you must contact us at 330-422-8332. You may pay here on the site using a credit card or you may also send through Cash App- $dreamsacademy or Zelle 330-422-8332. Can't wait to see you!

Student Information

Student Name

First Name

Last Name

Student Date of Birth

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What school does student attend?

Does your student have any health issues that would prevent them from basic exercise?

Any food allergies or restrictions that we should be aware of?

In a short paragraph, explain why your student would benefit from or needs to experience chosen program:

Parent/Guardian Information

Name of parent/guardian of student

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Last Name

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Address

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City

State/Province

ZIP/Postal Code

Annual Household Income

$10,000 - $25,000

$25,000 - $50,000

$50,000 - $75,000

$75,000 - $100,000

$100,000 +

Emergency Contact Name

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Last Name

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Dreams Academy is purely voluntary on the part of each participant. Reasonable precautions will be taken in the interest of safety. It is solely understood, however, that neither Dreams Academy nor any employee, sponsor or volunteer will be held liable for any accident, injury or illness that might occur while participating in Dreams Academy. I hereby grant permission to Dreams Academy or related organizations to use any photographs, video/audio recordings or any likenesses for publicity and promotional purposes such as television, print and radio broadcast. I acknowledge that I am releasing the fact that I am in some way associated with Dreams Academy and/or related organizations. By completing this form, entering my initials below and clicking “Submit Application” I hereby waive all claims for any compensation for such use and for damages. I also agree to pay the tutition cost of $100.

Acceptance and Initials