Form

General Information:
Parent/Guardian Name(s):*
Home Phone:*
Address:*
Participant’s Name:
Date of Birth:
Month Day Year
Present Age:
Sex:

Female Male
Entering Grade:
Does your child have any developmental or medical needs?:
Summer School 2011-2012
Pick your week(s) below by age range:
PRESCHOOL PROGRAMS FOR 2s-3s (2 and 3-years old on or after 3/1/11)
Week:

1: June 14-16 2: June 21-23 3: June 28-30 4: July 12-14 5: July 19-21 6: July 26-28 7: August 2-4 8: August 9-11 9: August 16-18
Days:

AM 3-Days Tuesday, Wednesday, and Thursday 9:15-12:15 PM 2-Days Tuesday and Thursday 1:00-4:00
ALL SUMMER FEES:

$75 3-DAY AM $55 2-DAY PM
PRESCHOOL PROGRAMS FOR 3s-4s (age 3 before 3/1/11 and 4 years olds)
Week:

1: June 14-16 2: June 21-23 3: June 28-30 4: July 12-14 5: July 19-21 6: July 26-28 7: August 2-4 8: August 9-11 9: August 16-18
Days:

AM 3-Days Tuesday, Wednesday, and Thursday 9:15-12:15 PM 2-Days Tuesday and Thursday 1:00-4:00 Connections - Tuesday
ALL SUMMER FEES:

$75 3-DAY AM $55 2-DAY PM NOTE: Connections Program pricing detailed by program description
SCHOOL AGE (entering kindergarten-entering 4th/grouped by age)
Week:

1: June 14-16 2: June 21-23 3: June 28-30 4: July 12-14 5: July 19-21 6: July 26-28 7: August 2-4 8: August 9-11 9: August 16-18
Days:

AM 3-Days Tuesday, Wednesday, and Thursday 9:15-12:15 PM 2-Days Tuesday and Thursday 1:00-4:00 Connections - Tuesday 9:15-12:15
ALL SUMMER FEES:

$75 3-DAY AM $55 2-DAY PM NOTE: Connections Program pricing detailed by program description
SCHOOL AGE (Kindergarten Readiness)
Week:

2: June 21-23 5: July 19-21 8: August 9-11 9: August 16-18
Days:

PM 2-Days Tuesday and Thursday 1:00-4:00
ALL SUMMER FEES:

$55 2-DAY PM
Should be Empty:

General Information:

Summer School 2011-2012

PRESCHOOL PROGRAMS FOR 2s-3s (2 and 3-years old on or after 3/1/11)

PRESCHOOL PROGRAMS FOR 3s-4s (age 3 before 3/1/11 and 4 years olds)

SCHOOL AGE (entering kindergarten-entering 4th/grouped by age)

SCHOOL AGE (Kindergarten Readiness)