Westerly Creek 2018 Spring Enrichments
Please complete this form to register for the 2018 Spring Enrichment Session
Student First Name
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Student Last Name
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Student's Grade/Teacher
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Parent/Guardian Name (s)
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Parent/Guardian Email(s)
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Parent/Guardian Contact Number(s)
Your answer
Emergency Contact/Authorized for Pick-Up (Name/Phone Number)
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Emergency Contact/Authorized for Pick-Up (Name/Phone Number)
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I do hereby authorize the NC staff to contact the person(s) named above in case of emergency
Your answer
How will child be leaving program? (Parent pick up, Discovery Link program, walk/bike on own, etc.)
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