Registration

Summer BootCamp Foundation Module 2025

Please choose a payment method:

Pay with PayPal/Credit card (Additional 4% charges will applicable) Pay With Zelle

Student Name *

Student Email

Student Phone Number

Grade *

School Name

Parent Name *

Parent Email *

Parent Phone Number *

City *

State *

Referred By (Name)

Referred By (Email)

How Did You Hear About Us ?

Early Bird Pricing of $599
if paid by July 25!
Regular price: $699

Additional Sibling Discount of 10%

$25 Referral Incentive for every registered and paid participant

Limited Sponsorship Spots
Maybe available for qualified participants

If a participant withdraws from the program before June 22, they are entitled to a 50% refund of the program fee paid. No refunds will be issued for withdrawals from the program after June 22. To request a refund, participants must notify us in writing at info@21iQInnovation.org Refunds will be processed within two weeks of receiving the withdrawal request. An additional 4% is applicable on transactions via PayPal or credit card.

Student Name *

Student Email

Student Phone Number

Grade *

School Name

Parent Name *

Parent Email *

Parent Phone Number *

City *

State *

Referred By (Name)

Referred By (Email)

How Did You Hear About Us ?

Early Bird Pricing of $599
if paid by July 25!
Regular price: $699

Additional Sibling Discount of 10%

$25 Referral Incentive for every registered and paid participant

Limited Sponsorship Spots
Maybe available for qualified participants

Student Name *

Student Email

Student Phone Number

Grade *

School Name

Parent Name *

Parent Email *

Parent Phone Number *

City *

State *

Referred By (Name)

Referred By (Email)

How Did You Hear About Us ?

Early Bird Pricing of $599
if paid by July 25!
Regular price: $699

Additional Sibling Discount of 10%

$25 Referral Incentive for every registered and paid participant

Limited Sponsorship Spots
Maybe available for qualified participants

Registration

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