After-School Enrollment Application

What is ImpactXR After-School Program?

Empowering Youth Through VR, Gaming, and Skills Development

Parent / Guardian First name

Parent / Guardian Last name

1st Child Full Name and Age

2nd Child Full Name and Age

3rd Child Full Name and Age

4th Child Full Name and Age

Email

Phone

Address

Schools

Select Attendance Type. (To Pay Weekly, Select "1" And Revisit Application Before The Following Week.

Weekly Attendance For 1 Child. (Select Number Of Weeks)$50

Weekly Attendance For 2 Children. (Select Number Of Weeks)$90

Weekly Attendance For 3 Children. (Select Number Of Weeks)$130

Weekly Attendance For 4 Children. (Select Number Of Weeks)$170

For Custom Attendance Dates Call Us At (478) 345-7373 Or Email Us At impactxr2@gmail.com

Select Weeks To Attend. (Please Make Sure Number of Weeks Selected Above Match The Number Of Weeks Selected Below.

Week 1 (Mon. - Thurs, / 3:30pm - 6:30pm)

CLOSED Week 2 (Mon. - Thurs, / 3:30pm - 6:30pm)

Week 3 (Mon. - Thurs, / 3:30pm - 6:30pm)

Week 4 (Mon. - Thurs, / 3:30pm - 6:30pm)

How did you hear about us?

Friends

Social Media

Other

Tell us about your student interest

By checking this box you understand and agree to ImpactXR's policy and procedures and that following service is non-refundable.

After clicking "Enroll Now" a staff member will contact you within 1 business day.