Junior Program FALL PAYMENT

  • Junior Program PAYMENT Form
    2023 Fall

  • Approval from the Pass Academy office is required before using this program Payment Form.
  • Please enter a number from 5 to 18.
  • Parent Information


  • Junior Program Options

    Fall: 9/5/23 - 10/29/23 (No classes on 10/9)

  • $0.00
  • American Express
    Supported Credit Cards: American Express, Discover, MasterCard, Visa
  • Medical Authorization & Release

  • MM slash DD slash YYYY
    By signing below, in an emergency, when I/we cannot be contacted, I/we hereby authorize the staff of the Pass Academy to take my/our child to the emergency room of the nearest hospital. I/we authorize that hospital and its medical staff to provide treatment deemed necessary for the well-being of my/our child.
  • MM slash DD slash YYYY
    By dating above, I agree to hold the Pass Academy and Bullis School harmless for injury or loss that may occur as a result of my participation in Pass Academy activities.
    I give permission for photos of my child participating in Pass Academy at Bullis programs to be taken and used for the Pass Academy Website and/or Facebook page. We understand that if students are identified, only their first names will be used.