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Learning Forward Education Center
Aftercare/Education Camp/Club Registration Form
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Email
*
Your email
Parent/Guardian Name
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Address
*
Your answer
Place of Employment
Your answer
Which program are you signing up for?
Aftercare
School Holiday Camp
Tutoring (Intensive Reading)
Homeschool (Homeroom Program)
Other:
Do you require transportation from school? Please Note our current pick-up schools are Creel, Croton, Harbor City, Roy Allen, Sable and Jonson Middle.
Yes
No
Clear selection
If you are registering for a holiday camp please indicate the specific camp here.
Your answer
Weekend Science Fair
Full Fair Jan. 28th 4PM - 6PM, Jan. 29-30th 11AM - 2PM
Child's Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Grade
*
pre-k
K
1
2
3
4
5
6
7
8
9-12
School Name
*
Your answer
Academic Concerns
Your answer
Allergies/Physical Conditions
*
Your answer
Behavioral/Developmental Challenges (we ask so we can help support your child)
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Second Emergency Contact Name & Phone Number
*
Your answer
Everyone who is allowed to pick up your child
*
Your answer
Anyone who is NOT allowed to pick up your child
Your answer
Insurance Company
Your answer
Family Physician & Phone Number
Your answer
Hospital Preference
Your answer
I give LFE Center permission to use my child's photos for their promotional material (e.g. website, social media, blog, flyer). Your child's photos will not be used for any other purposes outside of marketing material.
Yes
No
Clear selection
Send me a copy of my responses.
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