Information about your child
  Child’s name: *
  Grade (enter # only, i.e. 6): *
  School (# only, i.e. 144) *
  Classroom teacher *
  English ELA Level

4 3 2 1
  Math ELA Level

4 3 2 1
  Contact information
  Parent/Guardian’s Name *
  Name of person to pick up *
  Home Phone *
  Work/Cell Phone *
  E-mail Address *
  Emergency Contact Name *
  Emergency Contact Phone *
  Additional Information
  Which days will your child be attending the After-school Academy?  
  Monday       Tuesday           Wednesday        Thursday       Friday        Mon - Fri
  If you would like individual tutoring for your child, please indicate the desired subjects.  
  English             Math                 Writing              Test Prep     Chinese N/A
  What are you most concerned about regarding your child's academic performance?