Portsmouth Enrichment Programs

Hathaway Elementary School

Portsmouth Enrichment Incorporated
Hathaway Elementary School Foreign Language Enrichment Program
Registration-Emergency Information-Release Form

Spanish

Student First Name: Student Last Name:

Grade: Teacher:   

Which Enrichment Class:

Does your child have any allergies?

     If your child has allergies, what to?

Does your child have any special concerns or learning needs we should be aware of?

     If yes, please explain?


Parent Name:

Home Phone:   Cell Phone:   Work Phone:

Email:


Parent Name:

Home Phone:   Cell Phone:   Work Phone:

Email:


Emergency Contact:

Home Phone:   Cell Phone:   Work Phone:


Emergency Contact:

Home Phone:   Cell Phone:   Work Phone:


I’d like to volunteer as a classroom assistant. Yes or No.

I understand and agree to the guidelines. (please check)
[If you need to click away to read the guidelines use your "BACK" button on the browser to come back so you don't lose any information you've filled in.]


Parent/guardian _________________________________Date________________

Foreign Language Enrichment is not a fundraiser. The goal of the fee structure is to charge for real costs. A limited amount of financial aid is available. Class schedules will be sent home via backpack before classes begin.

A. Once you fill in the form correctly, please click the submit button. This will send the form to our data files and will present you with a page of your answers.


B. Please PRINT THAT PAGE (a copy for your records and a copy to send in with your check). Please send your check (payable to Portsmouth Enrichment Incorporated) and form to school via "backpack express" or mail to:

Foreign Language Coordinator
Hathaway Elementary School
53 Tallman Avenue,
Portsmouth, RI 02871

  Thank you!

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