BMC Elementary Summer Program, June 15 - June 19, 2020
Grades 2 and 3 are almost full. If your child is in grades 2 or 3, your child will be put on the waiting list.
Last Name *
Your answer
First Name *
Your answer
Grade Entering in Fall 2020 *
Tell us why you would like to enroll your child into the program. Please describe your child’s background / classes and math achievements (if any) in the space below.
Your answer
Gender (For statistical purposes only) *
Parent 1 email *
Your answer
Parent 2 email
Your answer
Parent 1 Name *
Your answer
Parent 2 Name
Your answer
Parent 1 Phone *
Your answer
Parent 2 Phone
Your answer
Out-of-State Emergency Contact: Name, Phone Number with area code, State *
Your answer
Does your child have serious medical conditions? If Yes, please specify in the next section *
If you answered "Yes" in the previous section, please list your child's serious medical conditions here
Your answer
Student's Address (Street/City/State/Zip Code)
Your answer
School, Name, Address
Your answer
What kind of school do you go to?
Preferred Name
Your answer
What race/ethnicity do you most identify with?
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