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2015 Summer Program Registration Form

Home / 2015 Summer Program Registration Form

Fields marked with an * are required

Please indicate the program your child is applying for (select one):

Student's Full Name:

D.O.B.

Gender:

Street Address:

City:

State:

Zip Code:

Phone #:

Is your child potty-trained? *

#1 Parent's Name:

Cell #:

Street Address:

City:

State:

Zip Code:

Home Phone #:

Work Location:

Work #:

Email: *

#2 Parent's Name:

Cell #:

Street Address:

City:

State:

Zip Code:

Home Phone #:

Work Location:

Work #:

Email: *

What is your anticipated summer schedule? (Please select):

Half Day (8:30AM-12:00PM)
Full Day (8:30AM-4:30PM)

Dates of Attendance:

WEEK 1 June 29th-July 2nd
WEEK 2 July 6th-July10th
WEEK 3 July 13th- July 17th
WEEK 6 August 3rd- August 7th
WEEK 7 August 10th- August 14th
WEEK 8 August 17th- August 21st

How did you hear about The Brunswick School?

Newsletter

Email *

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Contact

The Brunswick School
189 Brunswick St.
(7th Street entrance)
Jersey City, NJ 07302
(201) 420-1550
Info@TheBrunswickSchool.com

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