Strother Publc Schools - 21st Century Program

21ST CENTURY PROGRAM ENROLLMENT

THE 21ST CENTURY PROGRAM WILL BEGIN MONDAY AUGUST 28, 2017 AND WILL BE OFFERED MONDAY-THURSDAY FROM 3:15 PM-5:45 PM FOR GRADES K-8TH. A SNACK WILL BE PROVIDED FOR STUDENTS ATTENDING.

STUDENT NAME:

GENDER

Student Grade Level:

PARENT/GUARDIAN:

ADDRESS:

CITY

ZIP CODE:

PHONE NUMBER:

ADDITIONAL CONTACT NUMBER:

EMERGENCY CONTACT AND NUMBER

PLEASE MARK THE DAYS YOUR CHILD WILL ATTEND:

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

WILL STUDENT HAVE TRANSPORTATION HOME:

YES

PLEASE LIST AREAS OF INTEREST FOR ENRICHMENT ACTIVITIES: (EX. ARCHERY, FISHING, COOKING, COMPUTERS, ETC.)

Email a copy to

optional

Required Fields