Mary Fay Pendleton FUESD + BASE Programs Pre-Registration Form
Welcome to BASE Programs for the 2024 2025 school year, in partnership with FUESD Expanded Learning Programs! This program is located on site, after school at Mary Fay Pendleton School and is open to all TK-6th grade students. Please fill out a form for each of your students. This is a pre-registration document, please await a confirmation email to ensure your student's enrollment.  

For more information about BASE Programs please visit the website:
General Information: baseprograms.com Site Specific Information: baseprograms.com/maryfay

FUESD + BASE Programs 
This is an ELOP funded program.  All students grades TK-6th grade are eligible to apply.  Priority is given to UPP students at the time they apply.  UPP is defined as unduplicated, including one or more of the groups identified for additional funding under the Local Control Funding Formula (LCFF): Low Income (measured by Free/Reduced Lunch eligibility, which is different than the state's current free breakfast/lunch program for all students), English Learner, and Foster Youth.

We look forward to working with your students in the upcoming school year!
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Email *
Student's Full Name (first and last)
Estudiantes Nombre completo (nombre y apellido)
 *
Incoming Grade (24-25 School Year)
Grado entrante (año escolar 24-25)
 *
Birthday
Cumpleaños
 *
Home Address
Direccion de casa
 *
Primary Phone Number(s)
Número(s) de teléfono principal
 *
Primary Email Address(s)
Dirección(es) de correo electrónico principal
Father/Guardian Full Name
Nombre completo del padre
 *
Father/Guardian Phone Number
Número de teléfono del padre
 *
Mother/Guardian Full Name
Nombre completo de la madre/tutor
 *
Mother/Guardian Phone Number
Número de teléfono de la madre/tutor
 *
Emergency Contact #1 Name
Nombre del contacto de emergencia #1
 *
Emergency Contact #1 Phone Number
Número de teléfono del contacto de emergencia #1
 *
Emergency Contact #2 Name
Nombre del contacto de emergencia #2
 *
Emergency Contact #2 Phone Number
Número de teléfono del contacto de emergencia #2
 *
I authorize and consent to the use of my student's visual image for photography, video, electronic and print publications for appropriate program purposes
 *
Required
My student has medical conditions and/or allergies
Mi estudiante tiene condiciones médicas y/o alergias
 *
Required
If yes, please list all medical conditions and/or allergies
En caso afirmativo, enumere todas las afecciones médicas y/o alergias
Please share any details or additional information needed to help support your student
Comparta cualquier detalle o información adicional necesaria para ayudar a apoyar a su estudiante
 *
Parent Signature *by typing your name, you agree to the submission of this document
Firma de los padres *Al escribir su nombre, acepta el envío de este documento
 *
Do you have any other information or questions about this application?
A copy of your responses will be emailed to the address you provided.
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