2017 Summer Programs application
Student name (full name as shown on passport)
Your answer
Student number
Your answer
Date of birth (MM/DD/YYYY)
Your answer
Campus Enrolled
2017-2018 Grade Level
Student Gender
T-Shirt size
Session applying for
Will your child need busing?
Select a Bus line (2016-2017)
Parent/Guardian name
Your answer
Primary Phone Number (000-0000-0000, Please do type dash between the numbers)
Your answer
Alternate Phone Number (000-0000-0000, Please do type dash between the numbers)
Your answer
Parent E-mail Address
Your answer
Physical Address
Your answer
Alternative Emergency Contact Person
Your answer
Alternative Emergency Contact Phone Number (000-0000-0000, Please do type dash between the numbers)
Your answer
Please rate your child's swimming ability
Does your child have any medical condition/s or limitation/s (physical or emotional) that may necessitate care, affect their well-being or the well-being of others, or affect their ability to participate in summer program activities?
If "YES" please explain
Your answer
I understand that the above information is correct by indicating yes below.
What is your child's summer address for busing purposes?
Your answer
Submit
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