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Summer program Sign up form 
Choose a time
Select an option
Participant's information
Does your child have an IEP, 504 Plan, behavior plan, medical plan, or learning support plan?
Does your child have any allergies?
Current Educational Setting
Which Summer STEM Program format are you interested in?
Which schedule are you interested in?
Does your child take any medication during program hours?
Current Educational Setting
Choose all filds that may interest your child/ren
Choos all the tools that your child has experience wih
Virtual Participant's information
Will your child participate virtually at any point during the program?
If participating virtually, does your child have access to a computer, laptop, tablet, or Chromebook?
Does your child have reliable internet access?
Will an adult be available to support younger students during virtual sessions if needed?
Tuition, ESA, ACS, and Funding
How do you plan to pay for the Summer STEM Program? *
How do you plan to pay for the Summer STEM Program? *
If using ACS, ESA, voucher, or agency funding, do you understand that approval and payment authorization may be required before the student’s seat is fully confirmed? *
Are you interested in tuition assistance or a scholarship-supported rate? *
Do you give permission for your child to be photographed or recorded for program documentation, family updates, website, social media, or promotional purposes? *
Are you currently approved for ESA, ACS, voucher, or agency funding?
Are you interested in tuition assistance or a scholarship-supported rate? *
I certify that the information provided in this application is accurate to the best of my knowledge.
I understand that submitting this application does not guarantee enrollment. A seat is confirmed only after required registration steps, payment arrangements, funding approval, and program placement are completed.
I understand that attendance, participation, and safety expectations will be reviewed before the start of the program.
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Registration Fee


Our registration fee is $75 dollars for in-person and $50 for on-line

We accept the following payment methods

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paypal.me/xyayxthemovement

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$XyayXthemovement

XyayXthemovementcorp@gmail.com


Thank you for your interest in our summer immersive program. We welcome you to our community of learners, leaders, and friends.  Please fill out the online enrollment form, and print-out and return the filled out signed contract forms as soon as possible. Receiving the necessary information timely will ensure your child/rens prompt enrollment. Please do not hesitate to contact us if you have any questions or concerns at (646)598-8318 .  Also our email address is xyayxenrollment@gmail.com. We look forward to hearing from you.

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Contact Us

info@xyayxthemovement.org

718-450-3434

Locations

Brooklyn, NY – 340 Junius Street

Kinston, NC – 404 Dixon Street

SUBSCRIBE

Check & moneyorders

You can make checks/money orders out to:

XyayX The Movement

MAIL TO:

34 Junius St​

Brooklyn, NY 11212 

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Click here to make a immediate donation!

Paypal

Click here to make a recurring donation​

© 2025 XyayX The movement

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