Summer 2010 Enrichment Program Inquiry Form

Please send me more information on the 2010 AIM Summer Enrichment Program.

Your name:   First:  Last: required field

Street address:

City: ,  State:   Zip:

Email address: required field

Home phone: Daytime phone:

Please contact me by (check all that apply):
email home phone daytime phone

What program(s) are you interested in (check all that apply):

Elementary Enrichment Program (entering grades 1 - 6) 9:00 AM to 12:30 PM, $1995
The Schuylkill Center for Environmental Education (entering grades 1 - 6) 1:00 PM to 4:00 PM, $795
Upper School Enrichment Program (entering grades 7 - 11) 9:00 AM to 12:30 PM, $1995
Penn Charter Summer Camps (entering grades 7 - 11) 1:00 PM to 4:00 PM, $795
Interactive Metronome, All Grades, $1,500 for 15 sessions
Cogmed Working Memory Training, All Grades, $1600-$1800 for 25 sessions
Individualized Occupational Therapy, All Grades, Fee TBD
Individualized Speech and Language Therapy, All Grades, Fee TBD
Psychoeducational Evaluation, All Grades, Fee TBD

Do you have more than one child with learning disabilities?

Please tell us about your child. If you have more than one child who might attend the Summer Program, please describe the others in the comments section:

Child's Name: Age:

What school does your child currently attend?

Current grade:

Please tell us about your child's learning disability:

Additional comments: