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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