Waitlist FES SUMMER PROGRAM REGISTRATION

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2022

Email *

Student Name *

(If you have more than one child please complete a form for EACH child.)

Grade student will enter in September 2022 *

Entering Kindergaten in FALL 2022

Entering Grade 1 in. FALL 2022

Entering Grade 2 in FALL 2022

Entering Grade 3 in FALL 2022

Entering Grade 4 in FALL 2022

Parent or Legal Guardian Name *

Parent or Legal Guardian Cell Phone Number *

Additional Parent or Legal Guardian *

Additional Parent or Legal Guardian Cell Phone Number *

Parent or Guardian Email address *

Parent or Guardian Home address *

Home Phone Number *

#1 Emergency contact name and relationship *

The name & relationship of your emergency contact can be listed here. (ex. Jane Doe-Aunt)

#1 Emergency Contact Number *

The name & relationship of your emergency contact can be listed here. (ex. Jill Doe-Cousin)

#2 Emergency Contact Name & Relationship: *

Additional People to whom my child(ren) may be released: *

Please enter Name, Relationship and Phone Number of additional people to whom your child may be released. You may list up to 2 additional people. (ex. Jane Doe-Aunt-1234567890, Jill Doe-Cousin-1234567890)

Parent Signature *

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

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