2017 Summer Elementary Enrichment Courses Enrollment Form
Enrichment classes run Monday through Thursdays. No classes the week of July 3 - 6.

Classes will be held at Westside Elementary.

Please note: The grade levels listed for the class options are the grade the student WILL ENTER in the Fall of 2017.

Registrations must be completed by April 7, 2017.

Email address *
Student's Last Name *
Your answer
Student's First Name *
Your answer
Current Grade *
Required
Current School *
Required
Current Teacher's Name *
Your answer
Is student enrolled in morning Basic Skills class? *
Required
Parent/Guardian Name *
Your answer
Parent/Guardian Address *
Your answer
Home Phone (xxx) xxx-xxxx *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact's relationship to student *
Your answer
Emergency Contact's Phone (xxx) xxx-xxxx *
Your answer
Week 1
Week 1 & 2
Week 2
Week 3
Week 4
Week 4 & 5
Please indicate today's date (mm/dd/yy) *
Your answer
A copy of your responses will be emailed to the address you provided.
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