PARENT REGISTRATION "Back on Track" Academic Intervention Program
Please complete by no later than October 22.
Placement in classes is limited and will be filled on a first come, first serve basis.

Completing this online form will date stamp the registration.
Bring payment to an Open House at St Thomas More gym between 4-6:00 on Wednesday October 13 or contact Mary to make other payment arrangements at Mdemic914@gmail.com or text message to 917-288-8681.

FYI classes will be held on the following dates:
ELA Tuesday dates include -- November 2, 9, 16, 30 December 7, 14 January 4, 11, 18, 25.
Math Thursday dates include -- November 4, 11, 18 December 2, 9, 16 January 6, 13, 20, 27.
Email *
Parent name(s) *
Parent email(s) *
Parent phone number(s) *
Address *
List name of child or children and then list the preference(s). ELA 4-5:00 or 5-6:00 and/ or Math 4-5:00 or 5-6:00 *
Please indicate any health issues that we need to be aware of -- otherwise state none. *
List (2) emergency contact numbers for the time(s) you child will be in session. Include name and relationship to the child (children) *
Any other information or questions.
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