Summer Reading, Math and STEM Club Sign Up
Child's name:
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Grade (as of Spring 2018):
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Gender: Male / Female
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Age:
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Child’s Race/Ethnicity (for example: White, Hispanic or Latino, Other)
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Parent or guardian’s name:
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Email Address:
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Phone Number:
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Address (Street, House number, City, Zip Code)
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Parent or Guardian’s Race/Ethnicity (for example: White, Hispanic or Latino, Other)
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Do you speak a language other than English at home? If yes, what language?
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Questions about Reading
On a scale of 1 to 5, how much does your child enjoy reading? (1-least, 5-most)
2.) What was your child’s Reading/ELA MCAS score 2017 Spring (for K-3 it's Reading test and above it's called ELA)? Please circle one of the below answers:
Please list the last 2 books what your child read:
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Please list your child’s 2 favorite books:
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Is your child enrolled into ELL(English Language Learners) or LEP (Limited English Proficiency) group at school? Please choose one from below:
Questions about Math
What does your child like and dislike most about math?
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On a scale of 1 to 5, how much does your child enjoy math? (Please choose between 1 and 5)
Does your child practice math on their own?
What was your child’s Math MCAS score 2017 Spring? Please circle one of the below answers:
Food Allergy Questions
Please list your child’s food allergies, if there are any :
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Emergency contact in case of an allergy reaction. Guardian's or parent's name and phone number:
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Does your child have any medical concern, allergies or daily medication? If yes, please inform our Executive Director:
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