2018 Camp Concord Student Application Form English/Spanish
Student LAST name/ Apellido del estudiante *
Your answer
Student FIRST Name/Primer nombre del Estudiante *
Your answer
Current Teacher/Maestra Actual *
Your answer
Current School/Escuela Actual *
Grade Next Year/Grado el Próximo Año *
My child receives additional support through/Mi hijo recibe apoyo adicional a través de: *
Required
Parent's Name(s)/Nombre de Padre(s): *
Your answer
Home Address/Dirección de casa: *
Your answer
Home/Cell #/ Número de Casa/Celular: *
Your answer
Daytime Phone #: *
Your answer
Emergency Contact (name)/Contacto de Emergencia (Nombre): *
Your answer
Emergency Contact Phone #/Número de teléfono de contacto de emergencia: *
Your answer
Do you plan to use school transportation? (Please reference the Camp Concord paper copy when answering this question)/¿Planea usar el transporte escolar? (Por favor, consulte la copia en papel de Camp Concord al responder esta pregunta) *
Does your child have any medical conditions/¿Su hijo tiene alguna condición médica?? *
If so, please provide information regarding any allergies or medical information. If your child has none, please state none/Si es así, proveer información sobre alergias o información médica. Si su hijo no tiene ninguno, por favor, no mencione ninguno.. *
Your answer
I understand and support the importance of my child's daily attendance at Summer School each Tuesday & Wednesday on the following dates. (June 12, 13, 19, 20 & July 10, 11, 17, 18)/Entiendo y apoyo la importancia de la asistencia diaria de mi hijo en la Escuela de Verano cada martes y miércoles en las siguientes fechas. (12, 13, 19, 20 y 10, 11, 17, 18 de junio) *
The following questions are for Office Use ONLY/Las siguientes preguntas son para Uso ECLUSIVO de Oficina:
Does this student have an ESL Level? If so, please indicate below.
Does this student have an IEP?
Does this student have an Informal/Formal Behavior Plan?
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