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2019-20 APPLICATION
Before/After School
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State
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PARENT/GUARDIAN INFO
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
PERSONS (AGE 16 OR OLDER) AUTHORIZED FOR PICK UP OTHER THAN PARENT
EMERGENCY CARE INFORMATION
FINE ARTS SELECTION-NOW OFFERING BRASS!
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The Family Educational Rights and Privacy Act is a Federal law protecting student education records privacy. Parents have the right to inspect their child's records and request errors be corrected.

ACKNOWLEDGEMENTS
I understand that my child may be dismissed from the Afterschool/Summer Institute as a result of continuous discipline problems.
I agree that the program operator may authorize the doctor of their choice to provide emergency care if I nor the family doctor can be contacted.
I give permission for use of my child's photo and/or likeness in media related to the Afterschool/Summer Institute.
Scholarship Request
If Applying for Scholarship, Income Verification Required.

***$25 APPLICATION FEE REQUIRED TO PROCESS***

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