Summer Enrichment Program Application
June 8th - 12th, 8:00 a.m. - 2:00 p.m.
1.
Student Name
2.
Male/Female
Male
Female
3.
Date of Birth
4.
Current grade (2019-2020)
4th
5th
6th
7th
8th
5.
Home Address
6.
Custodial Parent/Guardian Name
7.
Emergency Contact Number