Summer Program View information about the Excelsior Academy – Suprex Learning summer program: SUMMER PROGRAM Enroll and pay here: Summer Program Enrollment Fee and Tuition Parent/Guardian Name* First Last # Students Enrolling*--1234Student 1 Name* First Last Student 2 Name First Last Student 3 Name First Last Student 1 Grade Level (Current School Year)(Select Grade Level)Pre-KindergartenKindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thStudent 2 Grade Level (Current School Year)(Select Grade Level)Pre-KindergartenKindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thStudent 3 Grade Level (Current School Year)(Select Grade Level)Pre-KindergartenKindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thEmail* Phone*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Current/Previous School NameLearning Disabilities Diagnosed (if applicable) ADHD ADD Dyslexia Dysgraphia Dyspraxia Autism (Average IQ) Autism (Below Average IQ) Other (add comments in Notes section of Form) If multiple students are enrolling - enter which learning disabilities each student has in the comments sections.# of Students for Enrollment Fee*Enter 1, 2, 3 or 4Enrollment Fee*March 1 to 31 (Regular)Apr 1 to July 1 (Late)(select based on the day of your enrollment)Tuition*Tuition - Full Time 4 WeeksTuition - Full Time 3 WeeksTuition - Full Time 2 WeeksPart Time Half Day - 4 WeeksPart Time Half Day - 3 WeeksPart Time Half Day - 2 Weeks# Students Paying Towards Tuition*(Enter 1,2,3, or 4)Which Summer Session are you enrolling in?* June- 4 Weeks July- 4 Weeks See https://excelsiorhouston.com/summer-program/ for dates and timesNotes to Administration Regarding Your PaymentGoals and Additional Comments About Your Needs(also include notes on the weeks your student will be in attendance if prorating weeks)Total $ 0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Cardholder Name Quantity