Summer at Sullins 2017
Student registration form for Sullins Academy 2017 Summer Program
Child's Name
Your answer
Birthdate
MM
/
DD
/
YYYY
Gender
Does your child have any allergies?
Your answer
Does the staff have permission to apply:
Required
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Grade in August 2017
School Attending
Your answer
Mother's Full Name
Your answer
Mother's Cell Phone #
Your answer
Place of Employment / Work Phone #
Your answer
Email Address
Your answer
Father's Full Name
Your answer
Father's Cell Phone #
Your answer
Place of Employment / Work Phone #
Your answer
Email Address
Your answer
Additional Persons Authorized to Pick Up (List Name and Phone Number)
Your answer
Weeks Your Child Will Attend:
$150 fee per week
Required
Electronic Signature
Your signature confirms that all information is correct, you agree to pay weekly fee of $150, and you are granting permission for your child to be included in photos/video which can be used by the school.
Your answer
Submit
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