paytest - Tutoring and Educational Services for High Potential

Operation Green School — REGISTRATION FORM

Please complete all requested information to register your child for our summer 2019 Green School sustainability program.
Questions? Please call (301)473-1102 or email ‘registration@positivearc.com’

Please complete and submit

Please select your session from the dropdown: *

Student Information:

Last name: *

First name: *

Age: *

Grade Entering fall 2019: *

Address: *

City: *

State: *

Zip: *

Parent/Guardian Information:

Name: *

Home Phone: *

Work Phone:

Cell Phone:

Email: *

Emergency Contact: *

Relationship: *

Phone: *

Please check if you give permission for your child to be photographed and possibly featured on our website or social media.

Additional Siblings Attending (sibling discount: 10% off each sibling):

Last Name:

First Name:

Age:

Last Name:

First Name:

Age:

Please list any allergies or medical information we may need to know for each child registered:

The following will also have permission to pick up my child. (Other than parents / ID will be required):

Name:

Relationship:

Phone:

Name:

Relationship:

Phone:

Location: Zion Lutheran, 107 West Main Street, Middleton, MD 21769.

Drop off and Pick up:

9:00a-12:00p session: Drop off is 8:45-9:00am; pickup is 12:00pm.

1:00p-4:00p session: Drop off is 12:45-1:00pm; pickup is 4:00pm.

Payments: Fee per session is $125 (less $12.50 per sibling discount, if applicable). Payment in full is required to complete registration, and may be made by credit card or check. Checks may be made out to ‘Positive Arc’ and mailed to: 703 East Main Street, Middletown, MD 21769.

Secure Payment

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