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University Park Fall 2017 Enrichment Registration
Please complete this form to register your student for the University Park Fall 2017 Enrichment Session.
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* Indicates required question
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student's Grade/Teacher
*
Choose
K - Havenar
K - Alley
K - Cardenas
K - Hale
1 - Hays
1 - Laurent
1 - Moss
2 - Archambault
2 - Reynolds
2 - Kaplan
3 - Jackett
3 - Smith
3 - Wilson
4 - Ostrom/Wise
4 - Morton
4 - Bryers
5 - McMahon
5 - Nakashima
5 - Kull
Not Listed
Parent/Guardian Name
*
Your answer
Parent/Guardian Email
*
Your answer
Parent/Guardian Contact Number
*
Your answer
Emergency Contact/Authorized for Pick-Up (Name/Phone Number)
*
Your answer
Emergency Contact/Authorized for Pick-Up (Name/Phone Number)
*
Your answer
I do hereby authorize the NC staff to contact the person(s) named above in case of emergency
*
Your answer
How will child be leaving program? Dismissed to Black Top (for AM Enrichment's ONLY),Parent pick up, Discovery Link program, walk/bike on own, etc.)
*
Your answer
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