Application for the 2017 Springfield Summer Program
Please fill out the following online application in order to have your child enrolled in The Springfield Summer Program. If you are enrolling more than one child, please fill out one online application for each child. Parents/Guardians will have to complete this online application in addition to the application in the Enrichment Brochure. Please be aware that your child will not be enrolled until both forms are submitted and payment has been received. Thank you for your cooperation! Springfield Summer Program Dates: Monday, June 26 - Tuesday, July 25, 2017 (Closed on Monday, July 3 & Tuesday, July 4).
Student's Last Name
Type in the last name of your child.
Your answer
Student's First Name
Type in the first name of your child.
Your answer
Age
Type in the age of your child.
Your answer
School
Choose the school that your child is currently attending.
Name of Your Child's Teacher
Type in the name of your child's current teacher. If your child presently attends FMG, type in the name of your child's homeroom teacher. Type Out Of District if your child is not enrolled in the Springfield School District.
Your answer
Out of District School and Town
Type in the current school and town if your child is not enrolled in the Springfield School District.
Your answer
Grade Completed on June 21, 2017
Street Address
Your answer
Town
Your answer
Zip Code
Your answer
Parent/Guardian's Last Name
Your answer
Parent/Guardian's First Name
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
This will be used as the primary form of communication for the Springfield Summer Program.
Your answer
Parent/Guardian's Last Name (Optional)
Complete this space if you would like to include both parents/guardians on the application.
Your answer
Parent/Guardian's First Name (Optional)
Complete this space if you would like to include both parents/guardians on the application.
Your answer
Email Address (Optional)
Complete this space if you would like to include both parents/guardians on the application.
Your answer
Emergency Contact
Type in the name of the person who will be contacted in case of an emergency.
Your answer
Emergency Number
Type in the phone number that will be used in case of an emergency.
Your answer
Please indicate any allergies, health concerns, or medications.
If this question does not apply to your child, please type NONE.
Your answer
8:30 - 9:30 First Choice Course
Click on the course that your child would like to enroll in.
8:30 - 9:30 Second Choice Course
You must choose a second choice course in the event that your first choice course is closed or cancelled due to enrollment.
9:30 - 10:30 First Choice Course
Click on the course that your child would like to enroll in.
9:30 - 10:30 Second Choice Course
You must choose a second choice course in the event that your first choice course is closed or cancelled due to enrollment.
10:30 - 11:30 First Choice Course
Click on the course that your child would like to enroll in.
10:30 - 11:30 Second Choice Course
You must choose a second choice course in the event that your first choice course is closed or cancelled due to enrollment.
11:30 - 12:30 First Choice Course
Click on the course that your child would like to enroll in.
11:30 - 12:30 Second Choice Course
You must choose a second choice course in the event that your first choice course is closed or cancelled due to enrollment.
Total Payment
Make checks payable to Springfield Public Schools or submit payment to www.myschoolbucks.com.
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