Summer School Application Form

Summer School Application Form
Student Information
Name*

First NameLast Name
Class*
School Last Attended
Gender*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first*
Emergency Information
Name*

First NameLast Name
Relationship*
Phone Number*
Health Information
Family Doctor

First NameLast Name
Clinic
Phone Number
Please let us know if this child have any allergies*
Can this child take part in regular physical activities?

YesNo
Do you want to indicate any related information?
Summer School Programs

Entering Week(s)*

	3 - 4.5 Years	4.5 - 6 Years
Week 1: 3 - 7 July 2023
Week 2: 10 - 14 July 2023
Week 3: 17 - 21 July 2023
Week 4: 31 July - 4 August 2023
Week 5: 7 - 11 August 2023

Date of Registration*

MonthDayYear
Date
Should be Empty:

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