Summer School Application Form
Student Information
Name
*
First Name
Last Name
Class
*
School Last Attended
Gender
*
Please Select
Male
Female
N/A
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / 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 Name
Last Name
Relationship
*
Phone Number
*
Format: (000) 000-0000.
Health Information
Family Doctor
First Name
Last Name
Clinic
Phone Number
Format: (000) 000-0000.
Please let us know if this child have any allergies
*
Can this child take part in regular physical activities?
Yes
No
Do you want to indicate any related information?
Summer School Programs
Entering Week(s)
*
Rows
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
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: