STEAM - Stay & Play (Thursday) Grades K-5, Session 2, Winter 2020 Registration Form
Please fill in each of the spaces below to register your child for Session 2, Winter 2020 of STEAM - Stay & Play (Thursday).


Class:  STEAM - Stay & Play (Thursday)
Day:  Thursdays from 2:25 - 3:50 pm
Dates:   3/5, 4/2, 4/9, 4/16, 4/30, 5/7, 5/14, 5/21, 5/28
Duration: 9 weeks
Teachers:  Mrs. DeNapoli and Mrs. Pontone
Location : Mrs. Testa’s room.

We will send out an email confirming your child’s enrollment. If your child is placed on a wait list, you will be notified.

ONCE YOU RECEIVE THE CONFIRMATION EMAIL, PLEASE MAKE A PAYMENT FOR $114 (including 15 supplies fee) TO THE MAIN OFFICE BY FEB 26, 2019.

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Student First Name *
Student Last Name *
Parent Name *
Parent Cell Phone *
Parent Home Phone *
Parent Work Phone
Parent Email Address *
Student's Teacher *
Teacher name (if not listed above)
Name of Emergency Contact #1 *
First and last name
Phone number of Emergency Contact #1 *
Name of Emergency Contact #2 *
First and last name
Phone number of Emergency Contact #2 *
Medical Information for Student *
Does your child have any medical issue (e.g., asthma, allergies, etc.) that instructor should be aware of?
Required
If your answer to the above question is "Yes", does your child require the use of: *
Epipen, inhaler, etc.?
Required
Read and sign YOUR full name below. *
Please be aware that the school nurse will not be around after regular school hours. It is very important that parents provide information about your child’s food allergy and medication to the Muraco After School Program (MASP) teacher(s) before the program starts.   By signing your name below, you agree to the following:  Your child (name referenced above), has your permission to participate in the Muraco After School Program(s) referenced above.  You understand that this may involve physical activity,  and you freely accept all risk of personal injury, and personally release the Muraco Elementary School, Town of Winchester, the Muraco Elementary School Parents Association, the program leader(s),  their members, employees, agents, representatives and those governmental agencies and other organizations affiliated with this program, from any and all liability, loss, damage, costs, claims and/or other causes of action, including but not limited to, all bodily injuries and property damage arising out of participation in the Muraco After School Program(s) referred to above, it being specifically understood that said program(s) may involve physical activity by the above-referenced minor.
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