Information about your child
Child’s name:
*
Child’s grade:
*
Child’s attending school
*
Child’s classroom teacher
*
Contact information
Parent/Guardian’s Name
*
Name of person to pick up
*
Address
*
City
*
State
*
Zip code
*
Home Phone
*
Work Phone
*
Cell Phone
*
E-mail Address
*
Emergency Contact Name
*
Program selection
- After-school Academy
5 days
4 days
3 days
2 days
-Enrichment Program
English
Math
Writing
Reader's Theater
Test Preps
Chinese
-Individual tutoring
English
Math
Writing
Test Preps
Chinese