Student's Home School / Escuela Hogar del estudiante
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Jefferson School #1
Washington School #2
Drago School #3
LMS
School #5
MLK Jr. School #6
Grant School #7
Pulaski School #8
Gero School #9
Roosevelt School #10
Cruise School #11
Ryan School #19
Student's Grade/ Grado de estudiante *
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Student Homeroom
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Parent/Guardian Last Name / Apellido de Padre/Madre *
Your answer
Parent First Name / Primer Nombre de Padre/Madre *
Your answer
Home Street Address / Dirección *
Your answer
Apartment Number / Número de Apartamento
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Home Telephone # / Teléfono del casa # *
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Cellular Telephone # / Teléfono celular # *
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Business Telephone # / Teléfono de trabajo
Your answer
Emergency Contact #1 / Contacto de Emergencia #1 *
Your answer
Emergency Contact #1 Telephone Number / Número de teléfono *
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Relationship to Student / Relación con Estudiante *
Your answer
Emergency Contact #2 / Contacto de Emergencia #2
Your answer
Emergency Contact Telephone Number #2 / Número de teléfono
Your answer
Relationship to Student / Relación con Estudiante
Your answer
Health Concerns, Physical Limitations, Medications or Allergies: (please describe or write NONE) / Preocupaciones sobre la salud, Limitaciones Físicas, Medicamentos o Alergias (por favor, describir)
Your answer
Yes, I will be responsible for transportation for my child to School #10 at 8:30am and pick them up at 12:00pm. / Entiendo que el Programa de Enriquecimiento Académico sábado se llevará a cabo en la Escuela Roosevelt # 10. *
Required
I grant full permission to the authorities of Passaic Public Schools for my son/daughter to participate in the Saturday Enrichment Academy. No student will be allowed to participate without this signed and completed form. / Yo doy permiso completo a las autoridades de las Escuelas Públicas de Passaic para que mi hijo/hija participe en la Academia del Sábado para Enriquecimiento Académico. A ningún estudiante se la permitirá participar sin el formulario firm ado y rellenado. *
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