Interboro Summer Enrichment 2017
Please complete the registration survey for EACH child you are registering.
Student's Name
Your answer
Student's School
Grade ENTERING in the FALL
Registration for Students Entering Kindergarten
Registration for Students Entering 1st or 2nd Grades
Registration for Students Entering 3rd-5th Grades
Total Payment ($55 per session)
Your answer
Payment submission
Emergency Contact Information - The following information MUST be complete for your child to participate in the Summer Enrichment Program
Home Telephone Number
Your answer
Parent's Name and Phone Number
Your answer
Relative or neighbor we may contact if parent(s) are not available (name and phone number)
Your answer
Physician to be called in the event of an emergency (name and phone number)
Your answer
Does your child have ANY special health problems, including allergies? If yes, please explain.
Your answer
Parent's Signature (Please type your full name)
Your answer
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