2019 Transfiguration School Summer Institute

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Registration does NOT guarantee a spot. We will confirm with you when your seat is secured. Thank you.

Registration, health info, emergency contact, and dismissal authorization to be completed for each student enrolling for the 2019 Transfiguration School Summer Institute.

$700.00 non-refundable deposit is required upon registration to confirm a seat for your child in the program. Payments can be made by credit card (3% administrative fee will apply) or by check, payable to Transfiguration School. The balance will be due immediately and balance due June 1st.

Contact info@transfigurationschoolnyc.org with questions.

Child's Last Name *

Child's First Name *

Child's Middle Name (if any)

Date of Birth (MM/DD/YYYY) *

Gender *

Female

Male

Is the child currently enrolled at Transfiguration School? *

Yes

If the child is currently not enrolled at Transfiguration School, please list the name of the current school and grade completed as of June 2019. (Please provide the most recent report card to admissions@transfigurationschoolnyc.org). Families will be notified via email once accepted.

Incoming Grade *

What tee-shirt is your child? *

Child's Cell Phone (if applicable)

Parent #1 Full Name (primary contact) *

Parent #1 Mobile Number *

Parent #1 Work Number

Parent #1 Primary e-mail address for all school communications *

Parent #2 Full Name (secondary contact) *

Parent #2 Mobile Number *

Parent #2 Work Number

Parent #2 Primary e-mail address for all school communications *

Full Home Address (include apartment, city, state, zip) *

Home Phone (Optional)

Will your child be enrolled in the After School Program? (Grades 1 to 6 only) *

Yes

No, my child is in Pre-Kindergarten or Kindergarten.

Doctor's Name *

Doctor's Address (optional)

Doctor's Telephone Number *

Hospital Name (preference) *

Known allergies *

Does your child require an EpiPen? *

Yes

Special medical/emotional considerations (if any)

Primary Emergency Contact's First & Last Name (Other than Parent/Guardian) *

Relationship to child *

Emergency Contact's Cell Phone *

Dismissal Person #1 First and Last Name (person authorized to pick up your child from Transfiguration School - I understand that it is my responsibility to inform the school staff of any additions to, deletions from, or changes to this form) *

Relationship to Child *

Dismissal Person #1 Phone Number *

Dismissal Person #2 First and Last Name (person authorized to pick up your child from Transfiguration School - I understand that it is my responsibility to inform the school staff of any additions to, deletions from, or changes to this form) *

Relationship to child *

Dismissal Person #2 Phone Number *

Permission for Dismissal at 3:00 PM (Grades 5 & 6 only) *

I give my child permission to walk home at 3:00 PM every day after the 2019 Transfiguration Summer School Institute.

I will pick up my child at 3:00 PM every day after the 2019 Transfiguration Summer School Institute.

Does not apply. Student is enrolled in After School nor in Grades 5 or 6.

Permission for Dismissal at 6:00 PM (Grades 5 & 6 in after school only) *

I give my child permission to walk home at 6:00 PM every day after the 2019 Transfiguration Summer School Institute.

I will pick up my child at 6:00 PM every day after the 2019 Transfiguration Summer School Institute.

Does not apply. Student is not enrolled in After School nor in Grades 5 or 6.

Parent's Signature (signed electronically) *

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