2019-2020 SEP Registration Form
Program Dates: 12/7, 12/14, 12/21, 1/11, 1/18, 1/25, 2/1, 2/8 Makeup Date: 2/29

Welcome to the Floral Park-Bellerose Saturday Enrichment Program! SEP is open to all Floral Park-Bellerose School District residents, Pre-Kindergarten through Grade 6. All classes will be held at Floral Park-Bellerose School.

WE ENCOURAGE ALL TO REGISTER ONLINE!

Program Fee: $75 for each 8 week course. Checks are payable to "Floral Park-Bellerose UFSD".

Payment by Check or Money Order:
1. Print "Registration Details" message (you will receive it after filling the form below).
2. Send it in with your check or money order payable to Floral Park-Bellerose UFSD, One Poppy Place, Floral Park, NY 11001.
3. Registration will be confirmed upon receipt of payment.

PLEASE DO NOT SEND IN REGISTRATION FORM THAT WAS SENT HOME IF YOU REGISTER ONLINE, ONLY SEND IN THE EMAIL CONFIRMATION WITH YOUR PAYMENT.

If you have any questions, please email SaturdayProgram@fpbsd.org.

9:00 Saturday Morning LEGO Club CLOSED
9:00 Space & Weather CLOSED
9:00 WeDo LEGO CLOSED
10:00 Be Yourself...Drama Kids CLOSED
10:00 Drill & Skill CLOSED
10:00 Early Childhood Arts & Crafts CLOSED
10:00 Gymnastics/Warrior Challenge CLOSED
10:00 Hip Hop Dance Academy CLOSED
10:00 Princesses & Superheroes CLOSED
10:00 Saturday Morning LEGO Club
10:00 Tennis CLOSED
10:00 WeDo LEGO CLOSED
10:00 YogArt CLOSED
11:00 Early Childhood Arts & Crafts CLOSED
11:00 Gymnastics/Warrior Challenge CLOSED
11:00 LEGO Machines CLOSED
11:00 Saturday Morning LEGO Club
11:00 Tennis CLOSED
11:00 WeDo LEGO CLOSED
Student Information
Student First Name *
Your answer
Student Last Name *
Your answer
Grade *
School *
FIRST SESSION 9:00-9:55
9:00 - 9:55 - Select Course *
9:00 - 9:55 - Alternate Select Course *
SECOND SESSION 10:00-10:55
10:00 - 10:55 - Select Course *
10:00 - 10:55 - Alternate Select Course *
THIRD SESSION 11:00-11:55
11:00 - 11:55 - Select Course *
11:00 - 11:55 - Alternate Select Course *
PAYMENT INFORMATION
Total Amount ($75 for each 8 week course) *
Payment *
Check # (if applicable)
Your answer
I understand that my child will be officially registered for the course(s) once payment is received. *
PARENT/GUARDIAN CONTACT INFORMATION
Parent Name (First & Last Name) *
Your answer
Home Address *
Your answer
Parent email address *
Your answer
Home Phone # *
Your answer
Cell Phone # *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone # *
Your answer
MEDICAL INFORMATION
Does your child have any medical conditions that we should be aware of? *
Required
If you said "yes" to your child having a medical condition, please give brief description.
Your answer
Would you like us to contact you before the program begins to discuss any concerns you may have regarding your child's participation in the program? *
I give my child permission to participate in the Floral Park-Bellerose Elementary School District's 2018-2019 Saturday Enrichment Program. *
HEALTH NOTICE: I am aware that there is not a registered nurse in the building during the program. In addition, the program coordinators do not have access to medications stored in the FPBS Health Office. If your child requires emergency medication, (i.e. inhalers, EPI pen, etc.) please see Mrs. Goldberg or Mrs. Hyland in the FPBS Main Office on the first day of the program. *
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