TIGER WOODS LEARNING CENTER SUMMER ACADEMY

JULY 15 20, 2012

WAYS TO REGISTER:
1. 2. 3. 4. Website: www.twlc.org E-Mail: summeracademy@twlc.org Fax this form to: 714.765.8059 Mail this form to: TWLC Summer Academy, One Tiger Woods Way, Anaheim, CA 92801

STEP 1: STUDENT INFORMATION PLEASE WRITE CLEARLY

Student First Name: __________________________ ___________________________ Date of Birth (mm/dd/yyyy): ______________ Gender: __ F __ M T-Shirt (Adult Size): ___________ MI: _____ Last Name:

STEP 2: PARENT CONTACT INFORMATION

Parent/Guardian First Name: ________________ ___________ Mailing Address: ______________________________ _________ Home Phone: (___) ______________ Work Phone: (___) ________________ _________________ Email: _________________________________ Cell Phone: (___) City: ____________________ State: _____ Zip: Last Name: ____________________ Relationship:

STEP 3: CLASS CHOICE

STEM Academy Please prioritize class preference (1-4): Comparative Zoology Resourceful Robotics Velocity Vehicles Video Game Design Please choose THREE Enrichment Workshops: Digital Art Comparative Marine Life Alternative Energy Rocketry Beginning Golf GOLF Academy (Enrichment Workshops are preset for GOLF participants)

Roommate Request (Optional for Overnight Participants) ________________________________ Request must be mutual(please list one name) Comments: _____________________________________________________________________________________

STEP 4: PAYMENT METHOD

ACADEMY SELECTION Overnight Academy Day Academy $950.00 $700.00

CHECK Included: Check Number: # ____________ Event Corp.

Make checks payable to Tiger Woods Charity

CREDIT CARD: Visa MasterCard Discover American Express Card Number: _______________________ Exp. Date: _________ Security Code/ 3 Digit #: ______________

Amount Billed to Card: $________ Name as it Appears on Card: __________________________ ____________________________ Billing Address: Same as the Mailing Address Signature:

Different (enter below) Zip:

Billing Address: _______________________________City: ____________________ State: _____ _________ Charge me the FULL TUITION AMOUNT Charge me the $250 deposit

TERMS & CONDITIONS: To reserve space, a deposit of $250 is required. This fee will be applied toward the tuition balance. Final payments MUST be received by May 15, 2012. Balance payments not received by May 15, 2012 may incur a $25 late fee. Any registrations taken after May 1, 2012 must be paid in full. If a deposit is paid by credit card and additional payment instructions are not received three weeks prior to the scheduled camp start date, Tiger Woods Learning Center will assume balance is to be charged to the credit card on record. No refunds will be issued for early withdrawal, absences, behavioral dismissal power failures or other

acts of nature. Fees for participants leaving early are NOT prorated. Balance payments, less deposits, are refundable up until three weeks prior to the start of the confirmed academy week. No refunds will be issued for cancellations within 3 weeks of the start of the confirmed academy week. All cancellations must be in writing and submitted to the Tiger Woods Learning Center no later than 3 weeks prior to the start of the academy. Tuition for the academy may not be transferred to another child. Refunds will not be issued without written cancellation confirmation from parent or guardian. All your data is confidential and NOT shared with other parties.