2020 Contact/Health/Consent Form Summer Academies
Please complete the following information. Registration is not complete until this form has been submitted.
Contact Information
Child’s First Name: *
Your answer
Child's Last Name: *
Your answer
School: *
Birthdate: *
MM
/
DD
/
YYYY
Grade Entering in September: *
Address: *
Your answer
City: *
Zip: *
Your answer
Home Phone: *
Your answer
Mother's Name: *
Your answer
Cell: *
Your answer
Email: *
Your answer
Father's Name: *
Your answer
Cell: *
Your answer
Email: *
Your answer
Are there any legal custody restrictions we should be aware of? *
If your child attends the Wyckoff Public Schools, do you give permission for The Summer Academies to access records in Genesis? *
List in order of preference, emergency contacts to be called if parents CANNOT be reached. In case of emergency, children will only be released to those named. *List the name(s) and phone number(s) below. *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Wyckoff School District. Report Abuse