Summer 2021 Registration Master Mailing List

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Welcome to our summer enhancement programs! Our 2 summer students (need names) will be offering many programs and activities in July and August. We would like to invite you to register to be on the mailinng list so we can inform you about all the great opportunities for you and your children that we have in store for you! (You will still have to register for individual programs and activities as they are organized).

Email *

What is your phone number? *

Adult First Name *

Adult Last Name *

Are you attending as a parent or as a caregiver? *

Parent of a child/ren 6 or younger

Caregiver of a child/ren 6 or younger

Both parent and caregiver

How many children under age 6 do you have/take care of? *

Child/children's first names and ages *

Are you a current member of Eastside Family Place? ($20/year, subsidy available for those that need it) *

Yes

No - I will bring $20 the first session we attend

No - I need to request a subsidy

Required: Have you signed a photo release form for ESFP? (On the form you can either choose to give consent, or not, but we need to collect this data) *

Yes

No - (We will have the forms on hand the first time you attend).

I'm a caregiver and I have to take the form for the parents to sign.

A copy of your responses will be emailed to the address you provided.

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