Project Most | Making the Most of Out of School Time

You can register your child for Project MOST online by filling our this form.

Would you like to register at at:
   John Marshall Elementary School
   Springs School

Child�s Name:

Address (Address, Town & Zip):

Email Address

Telephone Number (Home):

Telephone Number (Cell):

Child�s Date of Birth:

Child�s Gender:Male    Female

Child�s Birthplace:

Child�s Grade Level for September:
K 1 2 3 4 5 6 7 8

Employment

Mother/Guardian�s Name:

Place of Employment:

Employer�s Name:

Employer�s Phone Number:

Father/Guardian�s Name:

Place of Employment:

Employer�s Name:

Employer�s Phone Number:

Emergency Contact/ Pick Up Authorization

	Name:	Relationship:	Phone #�s:
1:
2:
3:

Medical Information
(all information will be kept strictly confidential)

Does your child have a medical condition that the Staff of Project MOST need to be aware of?:Yes    No
If YES, please explain:

Project MOST is not authorized to administer medication. Does your child take any medication that we need to be aware of?:Yes    No
If YES, please explain:

Are there any ALLERGIES we need to be aware of or any diseases that may be an issue while your child is in our care?Yes    No
If YES, please explain:

Parent Permission for Services:
By submitting this online application, I agree to the following:

I grant permission for my child to use all equipment and participate in all activities at Project MOST (Karate, Yoga, Dance, Art, Field Trips, cooking).
I grant permission for my child to attend swimming lessons at the YMCA (East Hampton Town Rec. Center).
I grant permission for my child to leave the school premises under adequate supervision by staff for offsite trips, outside play and recreation activities. I understand these activities may be taken at any time without further consent from me.
I grant permission for my child to be included in photographs or videos used in Project MOST.

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