FY 21 Congress MSAS Registration
Please fill out all sections correctly. If you need assistance, please email Shayla Johnson at
shayla.johnson@palmbeachschools.org
* Required
Email
*
Your email
Student Name:
*
Your answer
Student Date of Birth:
*
MM
/
DD
/
YYYY
Student Id#
*
Your answer
Which program are you interested in?
Morning Care Monday-Friday 7:45-8:44 ***MUST ARRIVE PRIOR TO 8:15***
Afterschool Monday-Thursday 4:15-5:45
Both
Student Grade Level:
*
Grade 6
Grade 7
Grade 8
Student Accommodation Status
*
General Education
ESE
504
Dietary restrictions/Allergies:
*
None
Vegetarian
Vegan
Kosher
Gluten-free
Other:
Parent/Guardian Name #1:
*
Your answer
Parent/Guardian Name #2:
*
Your answer
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