FY 22 Congress BASP Registration
Please fill out all sections correctly. If you need assistance, please email Shayla Johnson at shayla.johnson@palmbeachschools.org

***IF YOU HAVE MULTIPLE CHILDREN, PLEASE SELECT THE DUPLICATE TAB AT THE BOTTOM OF EACH QUESTION TO ADD ADDITIONAL INFORMATION FOR ANOTHER CHILD.***

MASK ARE REQUIRED-NOT OPTIONAL! *** Program begins September 8,2021***
Email *
Student Name: *
Student Date of Birth: *
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Student Id# *
Which program are you interested in?
Student Grade Level: *
Student Accommodation Status *
Dietary restrictions/Allergies: *
Parent/Guardian Name #1: *
Parent/Guardian Name #2: *
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