SE Registration Form

SUMMER ENRICHMENT PROGRAM

Child's Name:*

First

Last

Parent/Guardian Name:*

First

Last

Address:*

Street AddressCityState / Province / RegionPostal / Zip Code

Work/Cell Phone:

Area Code

Phone Number

Home Phone:*

Area Code

Phone Number

E-mail:

Last Grade Child Completed:*

T-Shirt Size:*

Please check which program child will participate:*

Enrichment Program (5/30-7/14) 10:00AM-2PM@$85/week/child

Full SE Program (5/30-7/14) 6:30AM-6PM@$95/week/child

Registration Fee: $50.00 Non-Refundable

Payment Type:*

Mail check to GWBBC

Bill Pay thru my Bank

Pay in person