SchoolPlus
Enrichment Program
for all ages, Pre-K to HS
To Register Online please fill in form below. Please make sure you recieve an e-mail from us confirming your registration. If you don't hear from us within 5 business days, please e-mail us at [email protected] or call 203.975.1134.

Location ................................................

Student (s) Information

1. Full Name .............................................

Age .........................................................

Grade as of Sep. 1, 2002 ...........................

Birthday ...................................................

Courses requested ....................................

2. Full Name .............................................

Age ..........................................................

Grade as of Sep. 1, 2002 ............................

Birthday ....................................................

Courses requested .....................................

3. Full Name .............................................

Age ..........................................................

Grade as of Sep. 1, 2002 ............................

Birthday ....................................................

Courses requested .....................................

Parent Information

Full Name (first parent or legal guardian) ......

Full Name (second parent or legagl guardian)

Street .......................................................

City ..........................................................

State ........................................................ Zip

Home Phone .............................................

Work Phone ..............................................

Cell Phone (s).............................................

E-mail (s) ...................................................

Additional contact information in case of emergency (phone #, name, relation)

Comments and Other Information

Comments ..................................................

How did you hear about us? ........................

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