2011 ACE Program Registration

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1. Please enter your children's names, ages, grade levels, and schools seperated by commas (e.g. John Smith, 11, 6th grade, St. Mary's Middle School)

Please enter your children's names, ages, grade levels, and schools seperated by commas (e.g. John Smith, 11, 6th grade, St. Mary's Middle School)   First Child
Second Child
Third Child
Fourth Child
Fifth Child

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2. Please list the academic subjects in which your children could benefit from supplimental instruction, and your child's most recent grade in those subjects (e.g. Geometry, B-).

Please be as specific as possible (e.g. list 'Algebra' instead of 'Math')

Please list the academic subjects in which your children could benefit from supplimental instruction, and your child's most recent grade in those subjects (e.g. Geometry, B-). Please be as specific as possible (e.g. list 'Algebra' instead of 'Math')   1.
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3. Which cultural activities might your children be interested in? (Check all that apply).

Which cultural activities might your children be interested in? (Check all that apply).   Regalia making Dance/Song Tribal History Language Fine Arts Lifeways (e.g. building longhouses, bows & arrows, etc.) Native Sports Native Food Museums/Art Exhibits Powwows Traditional Ceremonies Native crafts

4. Please list any special needs your children may have.

Please list any special needs your children may have.

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5. Please list the contact information for the parent or guardian who will be registering the child(ren) with the Piscataway Summer Charter Program.

Please list the contact information for the parent or guardian who will be registering the child(ren) with the Piscataway Summer Charter Program.   Name:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP/Postal Code:
Email Address:
Phone Number: