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
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