Summer Youth Program 2015 Enrollment Form

Summer Youth Program

Spanish American Center

112 Spruce Street, Leominster

978-534-3145

Ages/Edades: 5-18

Where/Donde: Spanish American Center 112 Spruce Street Leominster

When/Cuando: Junio 29 hasta Agosto 8/ June 29th to August 8th

Hours/Horario: 9:00 AM -12:30 PM

 

Niño/Child:                                                                                                                                                                                                                  

Edad/Age:

Direccion/address:

Alergia(s)/Allergie(s):

Padre(s)/Parent(s):

Telefono/Telephone:

Contacto de Emergencia/Emergency contact:

 

I will allow my child to be photographed: [YES] [NO]

Doy permiso para que mi hijo(a) sea fotografiado(a): [SI] [NO]

 

I will allow my child to go on local field trips: [YES]   [NO]

Doy permiso que mi hijo(a) participle and viajes locales: [SI] [NO]

 

My child is allowed to walk home: [YES] [NO]

My hijo(a) tiene permiso para caminar a casa: [SI] [NO]

 

 

 

 

 

 

 

 

Signature/Firma0