SAN Child Enrolment Form (All Venues)

Summer School

Enrollment Form
Summer Camp and Summer School

June 13th - July 29th, 2022

Monday - Friday 9am - 1pm

Free breakfast, lunch and supper
Which are you enrolling for?

Summer Camp (June 13th - July 1st) 9a- 1pSummer School (July 5th - July 25th) 9a - 1p
How many students are you enrolling?*

	Select all that apply
□Development Center
□Foster Family home/ Kinship Placement
□Health Institution
□ Hotels/Motels
□ Incarceration Institution
□Temporarily Unsheltered
□ Licensed Children’s Institution
□ State Hospital
□Residential School/ Dormitory
□Temporarily Sheltered
□ Temporarily Doubled Up

	Select all that apply
□Development Center
□Foster Family home/ Kinship Placement
□Health Institution
□ Hotels/Motels
□ Incarceration Institution
□Temporarily Unsheltered
□ Licensed Children’s Institution
□ State Hospital
□Residential School/ Dormitory
□Temporarily Sheltered
□ Temporarily Doubled Up

	Select all that apply
□Development Center
□Foster Family home/ Kinship Placement
□Health Institution
□ Hotels/Motels
□ Incarceration Institution
□Temporarily Unsheltered
□ Licensed Children’s Institution
□ State Hospital
□Residential School/ Dormitory
□Temporarily Sheltered
□ Temporarily Doubled Up

	Select all that apply
□Development Center
□Foster Family home/ Kinship Placement
□Health Institution
□ Hotels/Motels
□ Incarceration Institution
□Temporarily Unsheltered
□ Licensed Children’s Institution
□ State Hospital
□Residential School/ Dormitory
□Temporarily Sheltered
□ Temporarily Doubled Up

	Select all that apply
□Development Center
□Foster Family home/ Kinship Placement
□Health Institution
□ Hotels/Motels
□Temporarily Unsheltered
□ Licensed Children’s Institution
□ State Hospital
□Residential School/ Dormitory
□Temporarily Sheltered
□ Temporarily Doubled Up

Last Question...
Special Education Agreement
Choose one of the Following

Option A: My student has never received Special Education Services of any kind or a 504 Plan. (Example of a special education service is Speech, RSP, Occupational Therapy, ETC.)Option B: My student has an IEP or 504 Plan and I will upload the document and sent to the Enrollment Specialist so a special education team member can contact me and discuss the needs of my student
Please verify that you are human*
Should be Empty:

Summer School