Portsmouth Enrichment Programs

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Portsmouth Enrichment Incorporated
Melville Elementary School Foreign Language Enrichment Program
Registration-Emergency Information-Release Form

Student First Name: Student Last Name:

Grade: Teacher:    Which Enrichment Class:

Does your child have any allergies?

     If your child has allergies, what to?

Does your child have any special concerns or learning needs we should be aware of?

     If yes, please explain?


Parent Name:

Home Phone:   Cell Phone:   Work Phone:

Email:


Parent Name:

Home Phone:   Cell Phone:   Work Phone:

Email:


Emergency Contact:

Home Phone:   Cell Phone:   Work Phone:


Emergency Contact:

Home Phone:   Cell Phone:   Work Phone:


I’d like to volunteer as a classroom assistant. Yes or No.

I understand and agree to the guidelines. (please check)
[If you need to click away to read the guidelines use your "BACK" button on the browser to come back so you don't lose any information you've filled in.]


Parent/guardian _________________________________Date________________

Foreign Language Enrichment is not a fundraiser. The goal of the fee structure is to charge for real costs. A limited amount of financial aid is available.

Spanish Schedule (all classes to be held in the Library)
Level 1 – Mondays, 8:00 - 8:40 a.m.
Level 2 – Tuesdays, Dismissal to 4:05 p.m.
Level 3/4 – Fridays, 8:00 - 8:40 a.m.

A. Once you fill in the form correctly, please click the submit button. This will send the form to our data files and will present you with a page of your answers.


B. Please PRINT THAT PAGE (a copy for your records and a copy to send in with your check). Please send your check (payable to Portsmouth Enrichment Incorporated) and form to school via "backpack express" or mail to:

Foreign Language Coordinator
Melville School
1351 West Main Road
Portsmouth, RI 02871

  Thank you!

Validation Field(*Required):  to validate, please input portsmouth at left before submitting.