Santo Niño Regional

Catholic School Servicing Pre K - 6th

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Summer Reading Step Up Program Form

- Community

Summer Reading Step Up Program Enrollment Form
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- Weeks Attending REQUIRED Week 1 Week 2 Both Weeks Please fill out this field.
- Number of Students Enrolling REQUIRED Please fill out this field.
  
  Student 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2022/2023) REQUIRED Please fill out this field.
  
  Recommended by (Teacher's Name) REQUIRED Please fill out this field. Please enter valid data.
  
  Student 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2022/2023) REQUIRED Please fill out this field.
  
  Recommended by (Teacher's Name) REQUIRED Please fill out this field. Please enter valid data.
  
  Student 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2022/2023) REQUIRED Please fill out this field.
  
  Recommended by (Teacher's Name) REQUIRED Please fill out this field. Please enter valid data.
  
  Student 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2022/2023) REQUIRED Please fill out this field.
  
  Recommended by (Teacher's Name) REQUIRED Please fill out this field. Please enter valid data.
- Parent/Guardian 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Parent/Guardian 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
- Emergency Contact/Pick up
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
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