CHIME Enrichment Program Enrollment Form Survey

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1. Student 1 Last Name:

Student 1 Last Name:

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2. Student 1 First Name:

Student 1 First Name:

3. Student 2 Last Name:

Student 2 Last Name:

4. Student 2 First Name:

Student 2 First Name:

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5. Grade Level (Student 1):

Grade Level (Student 1):

6. Grade Level (Student 2):

Grade Level (Student 2):

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7. Teacher/Room # (Student 1):

Teacher/Room # (Student 1):

8. Teacher/Room # (Student 2):

Teacher/Room # (Student 2):

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9. Parent's Last Name:

Parent's Last Name:

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10. Parent's First Name:

Parent's First Name:

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11. Parent Phone #

Parent Phone #

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12. Parent E-mail:

Parent E-mail:

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13. Class(es) you would like to enroll your child in. If you are signing up two children for enrichment classes, please select classes for the child entered in the "Student 1" fields above on this question. Day of the week class is offered, grade level(s) for each class and price is included in parenthesis to the right of class title:

Class(es) you would like to enroll your child in. If you are signing up two children for enrichment classes, please select classes for the child entered in the "Student 1" fields above on this question. Day of the week class is offered, grade level(s) for each class and price is included in parenthesis to the right of class title: Kims Sports Classes (Mon., 2-3 $65)

MatheMagic! (Mon., K, $85)

MatheMagic! (Mon., 1-5, $85)

Who Wants to Make a Superhero Movie? (Mon., 1-5, $104)

Kims Sports Classes (Tues., 1-2 $56)

Kindermusik: Young Child 3 (Tues., 1-2, $110)

Kims Sports Classes (Tues., 4-5 $56)

Do You Want To Dance? (Tues., 1-8, $65)

Kims Sports Classes (Tues., K, $56)

Creative Scuplture! (Tues., K, $100)

Kindermusik: Young Child 1 (Tues, K, $95)

Creative Scuplture! (Tues., 1-5, $100)

Karate 4 Kids (Wed., K, $70)

Karate 4 Kids (Wed., 1-5, $70)

Kims Sports Classes (Wed., K, $73)

Kims Sports Classes (Wed., 3-4, $73)

Yoga for Children (Wed., 1-5, $117)

Lights, Camera, Action! (Wed., 6-8, $104)

Kims Sports Classes (Thurs., 1-2, $65)

Kims Sports Classes (Thurs., 3-4, $65)

Book Club (Thurs., 3-5, $75)

Animal Invasion! (Thurs., K, $85)

Animal Invasion! (Thurs., 1-5, $85)

Kindergarten Ballet (Thurs., K, $108)

Do You Want to Dance? (Fri., 1-8, $65)

Chess Club! (Fri., K, $75)

Chess Club! (Fri., 1-5, $75)

Anime, Cartooning, & Comic Book Creation! (Fri., K, $85)

Anime, Cartooning, & Comic Book Creation! (Fri., 1-5, $85)

Lego Robotics! (Fri., K, $85)

Lego Robotics! (Fri., 1-5, $85)

14. Class(es) you would like to enroll your child in. If you are signing up two children for enrichment classes, please select classes for the child entered in the "Student 2" fields above on this question. Day of the week class is offered, grade level(s) for each class and price is included in parenthesis to the right of class title:

Class(es) you would like to enroll your child in. If you are signing up two children for enrichment classes, please select classes for the child entered in the "Student 2" fields above on this question. Day of the week class is offered, grade level(s) for each class and price is included in parenthesis to the right of class title: Kims Sports Classes (Mon., 2-3 $65)