Raiders "STEAMing for Success" After-School Enrichment Program Application
Note:  Students must live in the attendance zone for Park Forest Middle to receive after school bus service for attending the program. If a student normally rides a transfer bus after-school, he/she will not be able to participate in the program.
電子郵件 *
Student Name
Grade Level
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Date of Birth
MM
/
DD
/
YYYY
Homeroom Teacher
Parent/Guardian Name
Address
City, State and Zip Code
Telephone (home)
Telephone (work)
Telephone (cell)
Please rank each of the following in order of choice for a concentration.
First Choice
Second Choice
Third Choice
Fourth Choice
4-H Club
Film Production
Music and Radio Production
Robotics
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Emergency Contact Name
Relationship
Address
City, State, and Zip Code
Telephone Number
In the event of an emergency, my preferred hospital is:
Does the child have any medical or physical problems that we should know about?
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If you answered yes to the previous question, please explain:
Dismissal Procedure
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提交
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