April Vacation Academy 2019
Holyoke Public Schools will be offering a STEM based April Vacation Academy. It’s an exciting, four-day Vacation Academy adventure with activities that explore connections between science, technology, engineering and innovation. Children will work together to create solutions to real-world problems and build critical STEM skills through engaging, hands-on activities, for students in grades 2 through 5. Classes are scheduled to begin on Monday, April 15, 2019 and run through Thursday, April 18, 2019 at Donahue Elementary School. In observance of Good Friday there will be no program on Friday, April 19, 2019. The hours of the program will be 8:30 am to 3:00 pm. Breakfast and lunch will be provided to all students. Transportation will be provided to students with pick up and/or drop off addresses one mile or greater from Donahue.

STUDENTS MUST BE REGISTERED BY MARCH 20, 2019.
If you have any questions please contact Sam Garcia , Assistant Director of Extended Learning (413) 534-2000 ext. 1409.

The following application must be completely filled out in order to be considered for the program. If you have more than one student applying for Vacation Academy, please complete one registration form for each student.

Student Last Name *
Your answer
Student First Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Current Grade *
Student's Current School *
Students Home Address *
Your answer
Students' current bus PICK UP Address (if student is a walker type N/A) *
Your answer
Students' current bus DROP OFF Address (if student is a walker type N/A) *
Your answer
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Primary Phone Number *
Your answer
Parent/Guardian Secondary Phone Number
Your answer
Parent/Guardian Email Address
Your answer
NO STUDENT WILL BE ENROLLED WITHOUT PROPER EMERGENCY INFORMATION. PLEASE LIST NAME & PHONE NUMBER OF EMERGENCY CONTACT OTHER THAN PARENT/GUARDIAN *
Your answer
Second Emergency Contact Name & Phone Number (optional)
Your answer
Will your child be attending all four days of Vacation Academy? *
What is your child's t-shirt size? *
Does your child have an IEP or 504 plan? *
May your child be photographed for newspaper, television, or social media? *
Will your child be taking any medications during program hours? If yes, please describe. You will also need to submit a doctor's note to your school nurse. *
Your answer
Does your child have any medical issues that staff should be monitoring? *
Your answer
Is your child allergic to any food? If yes, please specify which food(s). *
Your answer
Does your child have any other allergies? If yes, please describe the allergy and treatment. *
Your answer
Is there anything else we need to know about your child to ensure they have a safe and fun learning experience during Vacation Academy?
Your answer
Are you completing an application for more than one child? If yes, please list their name and school, otherwise type N/A. *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Holyoke Public Schools. Report Abuse - Terms of Service