Summer Enrichment Program 2011

Thank you for your interest in Parkside’s Summer Enrichment Program. We are excited to be able to engage your child in 6 weeks (8 weeks for Preschool and Kindergarten) of fun, project-based hands-on learning activities that will propel them to educational success. And they will be in a safe, family oriented environment

The theme for this summer is Sowing Good Seeds. Students will engage in activities that will coordinate with each weekly theme. Thank Activities include academic enrichment in reading, writing, math, and science/technology, as well as periods for active play and language lab. Afternoon projects will be fun hands-on activities that promote active learning and problem-solving. We will end each week with a field trip that allows students to interact with the weekly theme experientially. Download a flyer here.

Program Dates: Preschool and Kindergarten: June 27, 2011 - August 19, 2011; 1st - 10th: July 5, 2011 - August 12, 2011

Program Hours: 8:30 am to 5:00 pm. (You may drop your child off anytime between 8:00 am and 8:30 am. )

Program Cost: $190 per week; Siblings ($160 per week) - You must sign up for a minimum of 3 weeks.

Deadlines: May 1, 2011 (Deposit Due = 1/2 of total cost); June 1, 2011 (Final Payment Due)

You may apply to enroll your child in the Summer Enrichment Program below!

Summer Enrichment Program Registration Form 2011:

Check all weeks your child will attend. (You must select a minimum of 3 weeks.)

Week 1 is available to Preschool, Kindergarten and Bridge Program students ONLY.

Week 8 is available to Preschool and Kindergarten students ONLY.

(3 required)

	Week 1: June 27 to July 1			Week 2: July 5 to July 8
	Week 3: July 11 to July 15			Week 4: July 18 to July 22
	Week 5: July 25 to July 29			Week 6: August 1 to August 5
	Week 7: August 8 to August 12			Week 8: August 15 to August 19

Student Last Name

Student First Name

Student Nickname

Gender

Male

Female

Date of Birth

Ethnic Background

Primary Language

Use your Ctrl & Shift keys to select multiples.

Parent1/Guardian1 Name

10.

Relationship to Student

11.

Parent1/Guardian1 Street Address

12.

Parent1/Guardian1 City and Zip Code

13.

Parent1/Guardian1 Home Phone

14.

Parent1/Guardian1 Cell Phone

15.

Parent1/Guardian1 Email Address

16.

Place of Employment

17.

Occupation

18.

Parent1/Guardian1 Work Phone

For Parent2/Guardian2, only enter the information that is different from Parent1/Guardian1.

19.

Parent2/Guardian2 Name

20.

Relationship to Student

21.

Parent2/Guardian2 Street Address

22.

Parent2/Guardian2 City and Zip Code

23.

Parent2/Guardian2 Home Phone

24.

Parent2/Guardian2 Cell Phone

25.

Parent2/Guardian2 Email Address

26.

Parent2/Guardian2 Place of Employment

27.

Parent2/Guardian2 Occupation

28.

Parent2/Guardian2 Work Phone

29.

Marital Status of Parents/Guardians

Married

Single

Divorced

Separated

Widowed

30.

Student lives with:

Both Parents/Guardians

Mother

Father

Other

31.

If "Other", please indicate here who the students lives with.

EMERGENCY CONTACT PERSON (OTHER THAN PARENT)

32.

Name

33.

Address

34.

Home Phone

35.

Cell Phone

36.

Work Phone

37.

Student's Current School/Location

38.

Does your child have any unique learning needs/abilties that we should be aware of?

Yes

39.

If yes, please explain:

40.

Has your child been retained in any grade?

Yes

41.

If yes, please give the grade(s) and explanation:

42.

Place of Worship/Denomination

43.

How did you hear about the Summer Enrichment Program?

(1 required)

	PCA Parent			PCA Staff
	Internet Search			Alumnus/a of PCA
	Pastor			Friend
	Newspaper			Other

44.

Are you interested in learning more about Parkside Christian Academy or Cross Factor Academy?

Yes

STATEMENT OF RESPONSIBILITY

I understand that my child cannot attend unless a completed physician’s exam, including immunization record, is received by June 1, 2011.

I understand it is my responsibility to bring any special concerns about my child to the Director’s attention at the time of registration.

I authorize Parkside Christian Academy to have, use, publish, and reproduce photographs, slides, moving pictures or videotape of my child for its records or public relations efforts. No names will be used.

I grant permission for my child to participate in Parkside Christian Academy’s organized programs.

I have read the Tuition Schedule. I understand and accept the program’s policy concerning registration fees, tuition, and terms of enrollment.

I understand that once an application is accepted by Parkside Christian Academy, no refunds or transfer of funds will be made for withdrawal, dismissal, failure to attend, or incomplete attendance.

I understand the Director reserves the right to dismiss a student when, in her judgment, the student’s behavior interferes with the rights of others, the smooth functioning of the group or activity, or violates the Parkside’s principles of conduct.

I understand that Parkside Christian Academy cannot guarantee a space for my child if the payment terms are not met.

45.

I have read the Statement of Responsibility.

(1 required)

Yes

Type in the text that you see above:

Highlights from Summer 2010!

During the summer of 2010, we had an awesome time of learning and growing - academically, spiritually and socially. Parkside's Summer Enrichment Program was filled with an exciting exploration of knowledge in the classroom and outside. Approximately 100 students participated in project-based hands-on learning activities, and formed lasting friendships. Here are some pictures highlighting our time.