Junior Program Spring Payment

Junior Program SPRING PAYMENT

On-line PAYMENT for the Pass Academy Junior Programs at the Bullis School (Step 2 of 2)

Only use this form if you have filled out an On-line Junior Program SPRING APPLICATION, have received approval from the office, and were requested to make payment in order to secure the student’s spot in the requested/recommended session.
The 2026 Spring semester runs February 16^th through June 5^th.

"*" indicates required fields

Junior Program PAYMENT Form
2026 Spring

Approval from the Pass Academy at Bullis office is required before using this program Payment Form.

Student's Name*

First Last

Age*

Please enter a number from 5 to 18.

Parent Information

Parent's Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Parent's Email Address*

Enter Email Confirm Email

Parent Phone*

Junior Program Options

Spring: 2/17/26 - 6/5/26, Off 4/5, 5/25

TINY TOTS [5-6]

Price:

TT ~ Spring Options

Sat 11 - 11:45 ($430) TT

Sun 11 - 11:45 ($400) TT

PA KIDS [12 & under]

Price:

PA KIDS ~ Spring Options

Mon 5:30 - 7 ($800) PAK

Fri 5:30 - 7 ($920) PAK

Sat 11 - 12:30 ($860) PAK

Sun 11 - 12:30 ($800) PAK

DEVELOPING TOURNAMENT [9 - 14]

Price:

DTP ~ Spring Options

Sat 12:30 - 2:30 ($1140) DTP

Sun 12:30 - 2:30 ($1070) DTP

HIGH SCHOOL [13-18]

Price:

HSV ~ Spring Options

Tues 7 - 9 ($1220) HSV

Thurs 7 - 9 ($1220) HSV

Sun 4:30 - 6:30 ($1070) HSV

Total Fees

Credit Card*

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Session

Spring: February - June 2026

Medical Authorization & Release

Student Name*

First Last

Student Condition*

By checking this box it is understood that the student is in overall good physical health. If your child has a physical condition that may limit or restrict participation in certain activities, a physician’s note granting permission to participate in such activities must be presented prior to the first class session.

Date of Medical Authorization*

MM slash DD slash YYYY

By dating above, 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.

Date of Parent Release*

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.

Cancellation Policy*

By checking this box I accept the following policy. Cancel prior to 1st class: pay for 1 class. Cancel after 1st class: pay for 1 class plus $75 replacement fee. Cancel after 2nd class: pay for 2 classes plus $100 replacement fee. Plus credit card fees. No refunds after 3rd week. Medical reasons will be accepted with a doctor’s note.

Permission for Photo Use*

Yes

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.

Additional Information (optional)