Belle Sherman Enrichment Program
Registration Form for 2-5
Student Name (First Last)
Parent Name (*only one please*)
Parent Phone number (*only one please*)
Buchanan, Erin (2)
Millspaugh, Melissa (2)
Trdan, Allison (2)
Dresen, Josh (3)
Fay, Austin (3)
Reiff, Eric (3)
Frier, Shannon (4)
Thompson, Nancy (4)
Volpe, Joe (4)
Currier, Cody (5)
Paolangeli, Ashley (5)
Studelska, Katie (5)
Parent Email(s) (please enter ALL email addresses that you would like to receive class information, separated by commas)
Please enter ALL people who may pick up your child. (name, phone)
After class, student will
Go to Belle Sherman After School
Be Picked Up
Are you eligible for free or reduced lunch? This will not impact your chances of getting a spot, but will adjust your payment accordingly.
Not eligible (Full tuition)
Reduced Lunch (Reduced tuition sliding scale)
Free lunch (PTA sponsored sliding scale)
If you are eligible for the reduced tuition sliding scale, or PTA sponsored sliding scale, please indicate the amount you are able to pay. If you are not eligible, you can skip this question.
Emergency Contacts (name, phone) Please enter names of ANYONE ELSE you want to name as an emergency contact. (No need to repeat. Please make sure you have at least *two* name/phones listed somewhere on this form)
Notes, comments, etc.
Class Title - choose one class only from drop-down menu.
Kidz Hip-Hop Dance (Monday)
Pathfinder Role playing game (Monday session)
Pathfinder Role playing game (Thursday session)
Kung Fu (Tuesday)
Choose Health: Food, Fun, and Fitness (Tuesday)
Graphic novels (Tuesday)
Cool School Food (Monday)
Chemistry is fun (Wednesday)
Seishi Karate (Thursday)
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