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Summer Tutoring & Enrichment Program

Registration for S.T.E.P AHEAD

Program Selection

Please select which S.T.E.P Ahead program that you want to register for:

Student Information

Name:
Age:
Street Address:
City:
State:
Zip Code:
Home Phone:
Mobile Phone:
E-Mail Address:
2021 - 2022 School Year Grade Level:
T-Shirt Size:
Primary Transportation Method:

Family Inforamtion

Parent/Guardian's Full Name:
Relation To Student:
Street Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
E-mail Address:

Emergency Contact

In case of an emergency please contact:
Phone Number:
Relation to Student:
If for any reason I/we cannot be reached, please contact the following person(s) whom I/we hereby authorize to seek emergency medical or surgical care for my/ourchild:
Phone Number:
Relation to Student:

Dietary and Medical Information

Does the student you are registering have any medical issues we should be aware of:
If yes, please explain.:
Does the student have any special diet needs:
If yes, does the student have a disability that requires a special diet:
If yes, describe the major life activities affected by the disability.:
If no, list the medical condition that requires special nutrition or feeding needs.: