University Park Winter 2017-2018 Enrichment Registration
Please complete this form to register your student for the University Park Winter 2017-2018 Enrichment Session.
Student First Name *
Your answer
Student Last Name *
Your answer
Student's Grade/Teacher *
Parent/Guardian Name *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Contact Number *
Your answer
Emergency Contact/Authorized for Pick-Up (Name/Phone Number) *
Your answer
Emergency Contact/Authorized for Pick-Up (Name/Phone Number) *
Your answer
I do hereby authorize the NC staff to contact the person(s) named above in case of emergency *
Your answer
How will child be leaving program? Dismissed to Black Top (for AM Enrichment's ONLY),Parent pick up, Discovery Link program, walk/bike on own, etc.) *
Your answer
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