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WFSM LEC Student Application
Our hope is that by providing a space for students to complete school work along with other peers present will increase the feeling of being connected to school and increase motivation to complete their academics.
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* Indicates required question
Parent/Guardian Name
*
Your answer
Child's Name
*
Your answer
Child's Birthday
*
MM
/
DD
/
YYYY
Grade
*
Your answer
School
*
Your answer
Parent/Guardian Contact Phone Number
*
Your answer
Parent/Guardian Secondary Phone Number
Your answer
Parent/Guardian Email
*
Your answer
Parent/Guardian Address
Your answer
Would like to attend
*
Both Tuesdays 11:30 am noon to 3pm and Thursdays 11:30am to 3pm
Only Tuesdays 11:30am to 3pm
Only Thursdays 11am to 3 pm
Other:
Once confirmation of enrollment, I will complete a full registration form, medical and liability release forms and complete a telephone orientation prior to my child attending the WFSM LEC By checking the box, I agree to what is stated above.
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Yes
Required
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