Student's Name (if registering multiple children, 1 form must be completed PER child) *
Your answer
Student's School (for next school year) *
Grade ENTERING in the FALL *
Registration for Students Entering 1st or 2nd Grades
Registration for Students Entering 3rd-5th Grades
Total Payment ($55 per session) *
Your answer
Payment submission - Must be completed upon submission of form. (Make purchases with your credit/debit card or electronic check at www.MySchoolBucks.com.) Follow instructions in brochure. *
Emergency Contact Information - The following information MUST be complete for your child to participate in the Summer Enrichment Program
Parent's Name and Phone Number *
Your answer
Home Telephone Number *
Your answer
Parent's Email Address *
Your answer
Relative or neighbor we may contact if parent(s) are not available (name and phone number) *
Your answer
Students entering 1st - 5th grade: Transportation to and from your child's community school and Prospect Park School is available. Please indicate your transportation need (s) below. *
Required
Physician to be called in the event of an emergency (name and phone number) *
Your answer
Does your child have ANY special health problems, including allergies? If yes, please explain. *
Your answer
Parent's Signature (Please type your full name) *
Your answer
A copy of your responses will be emailed to the address you provided.