ELL Summer 2023 Transition Camp
The following form must be completed for students to be eligible for participation in the 2020 - 2021 LEAP Tutoring Program.
Adres e-mail *
Student First Name *
Student Middle Name
Student Last Name *
Grade Level for 23-24 School Year *
Date of Birth *
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Age *
Gender *
Student's Math Teacher *
Student Home Address (House Number and Street Name) *
Apartment Number
City *
Zip Code *
Parent/Guardian Name *
Parent/Guardian Cell Phone Number *
Parent/Guardian Work or Home Number
Parent/Guardian Working Email Address *
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact Address *
Emergency Contact Phone Number *
Does the student have ay medical or physical problems that we should know about? *
If you answered yes to the previous question, please explain.
Does the student take medication? *
If you answered yes to the previous question, please explain.
In the event of an emergency, my preferred hospital is *
Dismissal Procedure *
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