Application For The 2019 Springfield Summer Enrichment Program
Please fill out the following online application in order to have your child enrolled in The Springfield Summer Enrichment Program.  If you are enrolling more than one child, fill out one online application for EACH child.  Parents/Guardians will have to complete this online application in ADDITION to the application in the Enrichment Brochure.  Please be aware that your child will NOT be enrolled until BOTH forms are submitted and payment has been received.  Thank you for your cooperation.  Springfield Summer Enrichment Program Dates: Wednesday, June 26 - Wednesday, July 24, 2019 (Closed on Thursday, July 4)
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Student's Last Name *
Type in the last name of your child.
Student's First Name *
Type in the first name of your child.
Age *
Type in the age of your child.
School *
Choose the school that your child is CURRENTLY attending.
Name of Your Child's Teacher *
Type in the name of your child's current teacher.  If your child presently attends FMG, type in the name of your child's homeroom teacher.  Type Out Of District if your child is not enrolled in the Springfield School District.
Out of District School and Town
Type in the CURRENT school and town if your child is not enrolled in the Springfield School District.
Grade COMPLETED on June 25, 2019 *
Street Address *
Town *
Zip Code *
Parent/Guardian's Last Name *
Parent/Guardian's First Name *
Mr., Mrs. or Ms. *
Home Phone Number *
Cell Phone Number *
E-mail Address *
This will be used as the primary form of communication for the Springfield Summer Program.
Parent/Guardian's Last Name (Optional)
Complete this space if you would like to include both parents/guardians on the application.
Parent/Guardian's First Name (Optional)
Complete this space if you would like to include both parents/guardians on the application.
Mr., Mrs. or Ms. (Optional)
Complete this space if you would like to include both parents/guardians on the application.
E-mail Address (Optional)
Complete this space if you would like to include both parents/guardians on the application.
Emergency Contact *
Type in the name of the person who will be contacted in case of an emergency.
Emergency Number *
Type in the phone number that will be used in case of an emergency.
Please indicate any allergies, health problems, medications or limitations. *
If this question does not apply to your child, please type NONE.
8:30-9:30 First Course Choice *
Click on the course that your child would like to enroll in.
8:30-9:30 Second Course Choice *
You MUST choose a second choice course in the event that your first choice course is closed or cancelled due to enrollment.
9:30-10:30 First Course Choice *
Click on the course that your child would like to enroll in.
9:30-10:30 Second Course Choice *
You MUST choose a second choice course in the event that your first choice course is closed or cancelled due to enrollment.
10:30-11:30 First Course Choice *
Click on the course that your child would like to enroll in.
10:30-11:30 Second Course Choice *
You MUST choose a second choice course in the event that your first choice course is closed or cancelled due to enrollment.
11:30-12:30 First Course Choice *
Click on the course that your child would like to enroll in.
11:30-12:30 Second Course Choice *
You MUST choose a second choice course in the event that your first choice course is closed or cancelled due to enrollment.
Total Payment *
Make checks payable to Springfield BOE or Submit payment to www.myschoolbucks.com.
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