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Friendship Academy Enrollment FALL 2013
Please fill in the form below to register your child for the Friendship Club. Contact the HSU Family Psychology Center at 670-1531 if you have any questions.
1.
General Information
Parent/Guardian Name:
Address:
Address 2:
City/Town:
ZIP:
Email Address:
Phone Number:
2.
Child Information
Name
Age
Grade
School
Teacher
3.
Does your child have any allergies or dietary restrictions?
4.
Does your child have any special needs that we should be aware of?
5.
How did you hear about this program?