587 Springfield Ave | Summit, NJ 07901 | (O) 908-598-8088 | (F) 908-368-8628 | www.hwis.org New Jersey After School Enrichment Registration Form HudsonWay Immersion School Student Non-HudsonWay Immersion School Student Student Information Name: _________________________________ Gender: ________ Date of birth: ______/______/______ Current grade: ______________ Current school name & address: __________________________________ _____________________________________________________________________________________________ Parent Information Name of Parent/Guardian #1:_____________________________ Relationship to child:_________________ Email: _______________________________________________ Cell Phone:_________________________ Name of Parent/Guardian #2:_____________________________ Relationship to child:_________________ Email: _______________________________________________ Cell Phone:_________________________ Please check your selected class(es) and session(s) Day & Time Classes Per Session Fee Session I (Oct - Dec) Session II (Jan-Apr) Session III (Apr-June) Saturday 10:00 AM- 12:00 PM Abacus Class (Abacus Math and Mental Math for K and Elementary levels) $575 + $50 for materials including a textbook and an Abacus (12 classes) TOTAL Program Information • Classes are taught in English • Class offerings are subject to change per trimester. • Registrationn is first come, first served. • A completed registration form and full payment are required to reserve your child’s spot. • Please make checks payable to HudsonWay Immersion School and send with your registration form. Non-HudsonWay Immersion School students, please continue to complete the next page.
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Abacus Enrichment Registration Form - HudsonWay ...hwis.org/.../2014/08/Abacus-Enrichment-Registration-Form.pdfAbacus Class (Abacus Math and Mental Math for K and Elementary levels)
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New Jersey After School Enrichment Registration Form
HudsonWay Immersion School Student Non-HudsonWay Immersion School Student Student Information Name: _________________________________ Gender: ________ Date of birth: ______/______/______
Current grade: ______________ Current school name & address: __________________________________
Please check your selected class(es) and session(s)
Day & Time Classes Per Session Fee Session I (Oct-Dec)
Session II (Jan-Apr)
Session III (Apr-June)
Saturday 10:00 AM- 12:00 PM
Abacus Class (Abacus Math and Mental Math for K and Elementary levels)
$575 + $50 for materials including a
textbook and an Abacus (12 classes)
TOTAL Program Information
• Classes are taught in English • Class offerings are subject to change per trimester. • Registrationn is first come, first served. • A completed registration form and full payment are required to reserve your child’s spot. • Please make checks payable to HudsonWay Immersion School and send with your registration form.
Non-HudsonWay Immersion School students, please continue to complete the next page.
Allergies (Required, Non-HudsonWay Immersion School Students) If your child has any allergies or health concerns that we should be made aware of, please list them here: ________________________________________________________________________________________________
Medical Authorization (required for non-HudsonWay Immersion School students)
In case of emergency, please provide an emergency contact who can be called and is authorized to pick up you child if we cannot reach a parent. Emergency contact name: __________________________________ Phone: _______________________________
Relationship to child: ______________________________________________________________________________
Photo/Video Permission (required, non-HudsonWay Immersion School students)
When classes are in session, there are times when pictures or videos may be taken to showcase an activitiy or an event.
Photos or videos may be used internally or in school marketing materials, including our school’s website.
Yes, I give my permission to use pictures or videos of my child taken at classes, including on the internet and in printed
materials.
No, I do not give my permission to use pictures or videos of my child taken at classes. Pick-up/Drop-off Authorization (other than parent) (Required, Non-HudsonWay Immersion School Students)
Name: _______________________________________ Phone: ____________________________ Relationship to child: _____________________________________
This authorization applies as follow: _____Pick up _____Drop off
This authorized person will perform this function: _____Sometimes _____Always This authorization will remain in effect until canceled by me.