FASEP Information Form/Forma para Información
Please fill out this form once for each student you are enrolling in a FASEP class. This information is required for Administration of the FASEP program.
Student First Name
Your answer
Student Last Name/Nombre de familia del estudiante
Your answer
Student's Grade/Grado del estudiante
Your answer
Student's Room Number/El cuadro del estudiante
Your answer
Allergies/alergias:
Your answer
Does your child carry an Epi Pen/ ¿su hija/o carga con una pluma "Epi"?
Required
Additional medical, psychological, or behavioral issues that we should be aware of?/¿Otras cuestiones médicas, psicológicas, o conductuales de los cual debemos ser conscientes?
Your answer
Does your child attend an after-school program on campus?/¿Está inscrito su hijo en el Fairmont Afterschool Program?
If no, how is your child going to be picked up after class?/Si no, cómo será recogido su hija/o después de clase?
Your answer
Pick-up and drop-off location are at classroom listed on schedule. Schedule is subject to change based on the availability of space and instructors./Lugar para recoger y dejar al estudiante es en el salón indicado en el calendario. El horario puede cambiar debido a la disponibilidad de los salones y de los maestros.
If you have enrolled in a class at the Scholarship price, you must email a copy of your free/reduced lunch letter to yvelekim@gmail.com./Si inscrita en una clase al precio con beca, debe mandar su carta de almuerzo gratis o a precio reducido a yvelekim@gmail.com.
Parent or Guardian Name/Nombre del padre o tutor:
Your answer
Daytime phone number/Número de teléfono
Your answer
Email address/Correo electrónico
Your answer
Additional emergency contact name/Otra persona para contactar en caso de emergencia
Your answer
Additional emergency contact phone number/Número de teléfono para esa persona
Your answer
Contact Mike Levy (yvelekim@gmail.com) with any questions./ Si tiene alguna pregunta por favor comuníquese con Mike Levy (yvelekim@gmail.com)
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