<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><!-- saved from url=(0037)http://www.room5.com/application.html -->
FORESTHILL YOUTH ENRICHMENT PROGRAM
There will be a fee charged for the enrichment program based on the cost of the teacher, insurance costs and some supplies. Class costs will vary dependent upon classes chosen. Scholarships are available. Please make your checks payable to Room 5 Learning Centers. Students will not be registered for class until payment is received unless previous arrangements have been made. If class is discontinued for any reason, pro-rated refunds will be made. Please return the registration form and check to the school. For further information call Patty Fitzgerald, 367-3624. Classes will be cancelled if there are not enough students registered.
STUDENT CHOICE OF CLASS
First choice:
__________________________________________________________
Second choice: ________________________________________________________
APPLICATION
_________________________________________/_______________________________
Student Name / Grade Level
_________________________________________/_______________________________
Student Address / City Zip Code
________________________________________/__________________________
Parents Name / Home Phone Number
Emergency phone number __________________________________
Transportation:
____ I will pick up my child from school
____ My child will ride the bus home
I hereby give permission for my child _________________________ to participate
in the Foresthill Youth Enrichment Program.
Parent's signature __________________________ Date signed: _____________________
In case of accident or other emergency if parent or guardian cannot be reached I hereby authorize a representative of the Foresthill Youth Enrichment Program to make such arrangement as he or she considers necessary for my child to receive medical or hospital care including necessary transportation.
Parent's signature __________________________ Date signed: _____________________
This is not a