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2020 Contact/Health/Consent Form Summer Academies
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* Indicates required question
Contact Information
Child’s First Name:
*
Your answer
Child's Last Name:
*
Your answer
School:
*
Choose
Eisenhower
Coolidge
Lincoln
Sicomac
Washington
High School
Birthdate:
*
MM
/
DD
/
YYYY
Grade Entering in September:
*
Choose
K
1
2
3
4
5
6
7
8
9-12
Address:
*
Your answer
City:
*
Wyckoff
Other:
Zip:
*
Your answer
Home Phone:
*
Your answer
Mother's Name:
*
Your answer
Cell:
*
Your answer
Email:
*
Your answer
Father's Name:
*
Your answer
Cell:
*
Your answer
Email:
*
Your answer
Are there any legal custody restrictions we should be aware of?
*
Yes (If YES, please provide paperwork to the director)
No
If your child attends the Wyckoff Public Schools, do you give permission for The Summer Academies to access records in Genesis?
*
Yes
No
My child does not attend the Wyckoff Public Schools.
List in order of preference, emergency contacts to be called if parents CANNOT be reached. In case of emergency, children will only be released to those named. *List the name(s) and phone number(s) below.
*
Your answer
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