Excellence in Action Registration Form 2019
The Excellence in Action program is designed by Thoreau staff members to provide students with the essential background knowledge and skills that will help them have a successful transition to middle school.

Please answer the questions below to register for the Excellence in Action program to be held at Thoreau Middle School.
The cost of the program is $80. The registration fee will cover the instructional expenses plus lunch for your student and a Thoreau t-shirt.

Payment must be made through the FCPS online payment site, "My School Bucks .com" https://www.myschoolbucks.com/ver2/login/getmain?requestAction=home
in the School Store section of your child’s elementary school.

If you child did not attend a FCPS elementary school then a check made payable to “Thoreau Middle School” can be made and sent to the front office c/o EIA program.


You will receive a confirmation email within 3 weeks once your form and payment are processed.

Please indicate which session your child will attend: *
Student’s Last Name *
Your answer
Student's First Name *
Your answer
Male/Female: *
Grade level *
Elementary School *
Parent /Guardian Name *
Your answer
Parent/Guardian Email Address: *
Your answer
Parent Phone Number *
Your answer
Mailing Address: *
Your answer
Emergency Contact: *
Your answer
Emergency Contact Phone Number *
Your answer
Please indicate how your child will be transported to and from Thoreau Middle School: *
Required
Please indicate how you will be paying for the Camp. Checks should be payable to Thoreau Middle School *
Please choose your student’s adult t-shirt size: *
Student Allergies (list): *
If you answered yes, what type of food allergy?
Your answer
Medications that they will bring to the program:
Your answer
Special Education Needs (504, IEP, ESOL)
Your answer
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