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1st and 2nd - Episcopal Homework START 2016-2017

1.Parent/Guardian #1 Contact Information(Required.)

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

2.Parent/Guardian #2 Contact Information

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

3.Are you an Episcopal Academy faculty member?(Required.)

Yes

No

If yes, please specify your position:

4.Will you be instructing in Episcopal Academy's After School Enrichment Program this year?(Required.)

Yes

No

If yes, please specify your position:

5.Please select from the following:(Required.)

My child(ren) is currently enrolled in Aftercare or Enrichment for the 2016-2017 school year and I do not need to update emergency contact and authorized pickup information.

My child(ren) is currently enrolled in Aftercare or Enrichment for the 2016-2017 school year and I need to update emergency contact and authorized pickup information.

My child(ren) is not enrolled in Episcopal Academy's Aftercare or Enrichment programs for the current school year.