Parent/Guardian Signature Emergency Contact Person Telephone 4 week Courses for K-6 Period 2 4, 9:00-12:00 Session 1 – Session 2 Period 1, 8:00-9:00 Session 1 Period 3, K-2, 10:00-11:00 Course: Session 2 Session 1 Period 2, 9:00-10:00 Academic Support/Tutoring Session 2 Course: Please specify area of concern and Period 4, Gr 3-6, 11:00-12:00 Period 3, 10:00-11:00 session (s) Session 1 Course: Period 1, K-2 8:00-9:00 Session 2 Period 4, 11:00-12:00 Session 1 Course: Session 2 Period 2, Gr 3-6, 9:00-10:00 Drama Course I enclose $ ______________for full registration Checks made payable to: Town of Braintree Return application, payment and medical information to: Hollis School Marilyn Connell, Spark Director 482 Washington Street Braintree, MA 02184 Questions – please email – If you are late picking up your student, a $5.00 late fee will be assessed for 15 minutes past the ending time of the student’s class. Medical Information Student Name Date of Address Please check all that apply to your child: Asthma, Inhaler used? Yes No Allergies (food, insects, medications, environment), Specify: Epi-Pen used? Yes No Benadryl used? Yes No Diabetes Condition Seizure Disorder
Parent/Guardian Signature Emergency Contact Person Telephone 4 week Courses for K-6 Period 1, 8:00-9:00 Course: Period 2, 9:00-10:00 Course: Period 3, 10:00-11:00 Course: Period 4, 11:00-12:00 Course: Drama Course Period 2 – 4, 9:00-12:00 Session 1 Session 2 Academic Support/Tutoring Please specify area of concern and session (s) Period 1, K-2 8:00-9:00 Session 1 Session 2 Period 2, Gr 3-6, 9:00-10:00 Session 1 Session 2 Period 3, K-2, 10:00-11:00 Session 1 Session 2 Period 4, Gr 3-6, 11:00-12:00 Session 1 Session 2 I enclose $ ______________for full registration Checks made payable to: Town of Braintree Return application, payment and medical information to: Hollis School Marilyn Connell, Spark Director 482 Washington Street Braintree, MA 02184 Questions – please email – If you are late picking up your student, a $5.00 late fee will be assessed for 15 minutes past the ending time of the student’s class. Medical Information Student Name Date of Address Please check all that apply to your child: Asthma, Inhaler used? Yes No Allergies (food, insects, medications, environment), Specify: Epi-Pen used? Yes No Benadryl used? Yes No Diabetes Condition Seizure Disorder
Spark_brochure_2018_5-1-18.docx