Plainfield SD 202

ESY Program Registration

Step 1 of 3 - Parent Information

Your Name:

This field is required.

Your Email:

This field is required.

Your Main Phone #:

This field is required.

Your Cell Phone #:

This field is required.

Your Home Address:

This field is required.

Your Employer (for emergency use only):

Company/Name:

This field is required.

Employer Phone #:

This field is required.

Step 3 of 3 - Student Information

Student Data

Student Name:

This field is required.

Student Gender:

male

female

This field is required.

Student Birthday:

This field is required.

Student Current School:

This field is required.

Student Current Grade Level:

This field is required.

Choose the program your child was recommended to attend during ESY:

Related Services Only

2 Day or 4 Day ESY program

Private Placement

This field is required.

Will this student require transportation:

Yes, I need transportation

No, transportation is not needed

This field is required.

REMOVE STUDENT

ADD ANOTHER STUDENT

All ESY applications will receive an email at the email address you listed above. Make sure to check your inbox and spam. If you do NOT receive an email immediately following the submission of your application, please contact your child???s school. All future communication about ESY will come to this email address.

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ESY

ESY Registration

ESY Registration

Events

Spring Break

Spring Break

Spring Break

Spring Break

Spring Break

ESY Program Registration

Your Employer (for emergency use only):

Emergency Contact 1:

Emergency Contact 2:

Student Data