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Summer Prep Application

Please complete the form below. All fields are required.

BASIC INFORMATION

Student Information

Gender*
Answer Required

    

Parent/Guardian Information

    

    

Emergency Contact Information

Parent Authorization Release Form

Please indicate name, address, and telephone number of someone else that may pick up your child:

Student Enrollment Agreement

SECTION I: Walking Home

All children must be picked up by 4:30 p.m.

Please check one:*
Answer Required

SECTION II: Release Authorization

Field Trips:*
Answer Required
Photo Release:*
Answer Required

Medical Form

Medical Coverage Information

Medications and/or Allergies

Note: If your child is accepted into the program, please have him/her bring any medication that may be needed for treatment of a condition or allergy to school on the first day of the program.