Summer LAF - Middle School Registration

---------------------------- Middle School Registration Form ----------------------------

Student First Name	*
Student Last Name	*
Date of Birth	*
Address1	*
Address2
City	*
State	*
Zip	*
Telephone	*
Cell Phone
Email	*
Parent/Guardian Name	*
Emergency Contact	*
Emer. Contact Telephone	*
Grade in Fall 2008	*
Name of Current School
Special Health Conditions (if any, please explain)
Dietary Restrictions (if any, please explain)

Registering For:
Sessions	*	Session 1 (June 23, 2008 thru July 18, 2008) Session 2 (July 21, 2008 thru August 15, 2008)

Session 1 Course Elective		Art (MS-A) Computer, Level I (MS-C1) Computer, Level 2 (MS-C2) History through the Arts (MS-HttA) Science (MS-SC)
Session 1 Language Elective		Arabic Farsi French Spanish
Session 2 Course Elective		Art (MS-A) Computer, Level I (MS-C1) Computer, Level 2 (MS-C2) History through the Arts (MS-HttA) Science (MS-SC)
Session 2 Language Elective		Arabic Farsi French Spanish
Would you like school provided lunch?	*	Yes No
Would you like school provided transportation?	*	Yes No
Would you like to register for after-care (3:15pm - 6:00pm)?	*	Yes No

Payment Type		Check MasterCard Visa
Credit Card Number
Exp. Date

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