Norwood Extended Day February Vacation Registration 2022

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Parent/Guardian #1 First Name: *

Parent/Guardian #1 Last Name: *

Parent/Guardian #1 Email Address: *

Parent/Guardian #1 Cell Phone: *

Parent/Guardian #1 Work Phone: *

Optional—Parent/Guardian #2 Contact Info (First & Last Name):

Optional—Parent/Guardian #2 Email Address:

Optional—Parent #2 Cell Phone & Work Phone (Please indicate with W: & C: labels)

Child’s Street Address: *

Emergency Contact #1: First & Last Name & Relationship *

Emergency Contact #1: Phone Number *

Emergency Contact #2: First & Last Name & Relationship *

Emergency Contact #2: Phone Number *

Child First Name: *

Child Last Name: *

Child's Date of Birth *

YYYY

Child Gender: *

Male

Female

Non-Conforming

Prefer not to answer

Other:

Required

Child's CURRENT Grade: *

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Child's School: *

Balch

Callahan

Cleveland

Oldham

Prescott

Willet

Child Allergies/Medical Needs: *

Child Medications: *

Primary Language: *

Child Hobbies/Interests (ie. loves sports, takes ballet, etc.):

Any distinguishing characteristics/features (ie. soft spoken, lots of energy, wears glasses for reading, etc.)

Photographs/Media: I permit Norwood Extended Day to take photographs of my child engaged in sports, arts, and science activities to be shared on the NPS Website and NORWOOD EXT DAY Facebook Social Media Page. *

Yes

Other:

I would like to learn more about the financial aid process for my children. *

Yes

Other:

Optional—Comments or Additional Feedback?

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