2015-2016 Langlade Enrichment Program Registration Form – Fall / Early Winter

Please complete one form for each student. You may select more than one class on the same form. Student Name: _____________________________________________Grade: _______Teacher: ____________

Mailing Address: ___________________________________________________________________________

Parent (Guardian) Name(s): ____________________________________ Home Phone : __________________

Primary Email: _____________________________________________ Cell Phone: _____________________ Please list an email that you check regularly. This will be our main method of communication.

Parent(Guardian) Signature: ___________________________________________ Date: _________________

My child may be photographed for Langlade or vendor publications and marketing materials. Yes No

My child will be getting home in the following manner (ie. picked up, walking, etc.)

Emergency ContactName: _________________________________________________________ Relationship: ______________

Phone Number: _______________________ Any medical issues we need to be aware of: ________________

Please return the completed form to the school office with your tuition payment attached by the “Register By” date. All checks payable to Langlade PTO. You can use one check for multiple classes.

Please check the enrichment program(s) you wish to register for:

Foreign Language Grades Open to: Register By:

Beginner Spanish $45 K – 5th 10/2/15

Science/Experimenting Grades Open to: Register By:

Camp Invention – Castles, Catpults & Coats of Arms

$59 2nd - 5th 10/14/15

Crafting Grades Open to: Register By:

Winter Keepsake $16 4K - 2nd 11/20/15Winter Keepsake $16 3rd – 5th 11/20/15

* Tuition scholarships are available to participate for free to those who qualify for free/reduced lunch. Please “x”

Extra copies of this form can be found under the "Enrichment" tab on www.langladepto.org.