To print
Enrollment Form click your web browser
print icon above
Trinity Lutheran Church’s
G.R.O.W. in the Son Beyond-School Program
2008 Summer Enrollment Form
Summer registration
Indicate planned usage: _____ Entire summer- (Please note that the Program will be closed June 2-6 and July 4.)
Or
(check weeks your child will be in attendance)
May 27-30
____
June 30-July 3 ____
July 28-Aug 1 ____
June 9-13
____
July 7-11
____
August 4-8
____
June 16-20
____
July 14-18
____
June 23-27
____
July 21-25
____
Days Desired
_____ M-F
_____ M/W/F
_____ Tu/Thurs
_____ Other part-time (indicate days preferred
_________________________________________
Child’s Name: ___________________________________ Sex: ______ Age: _______________
Address: ______________________________________________________________________
Date of Birth: _______________________ Home Phone: _______________________________
Father’s Name: _____________________________________Marital Status: ________________
Place of Employment: _______________________________Work #: _____________________
Mother’s Name: ____________________________________Martial Status: _______________
Place of Employment: _______________________________Work #: _____________________
Mother’s Cell Phone #
____________________ Father’s Cell Phone #_____________________
(If the Program is to prevent a father or mother from picking up or visiting
your child, we
must have a copy of the legal document on file in our office.)
Are you currently
receiving financial assistance through the child care assistance program
administered through Community Child Care Connection, Inc.? _____Yes _____
No
The G.R.O.W. in the Son
Program is open to all K-Grade 6 children regardless of religious
affiliation. Please complete the following:
_____ Attend or a member of Trinity Lutheran Church
_____ Attend or a member of (church
name)______________________________________________
_____ Currently unchurched
____________________________________________________
________________
Signature of Parent/s
Date