PROJECT ADEPT REGISTRATION FORM


District: ________________________Work Phone:______________ Contact: _______________________ E-Mail ___________________ ADEPT Program:__________________________________________ Date of Program:_____________________ Students Attending: If not enough space please use back. _________________________ _________________________ _________________________ _________________________


_______________________ _______________________ _______________________ _______________________


Authorized Signature for Billing: _____________________________


Do not make payment—Your district will be billed Districts are required to provide all bussing arrangements and chaperones as per their dis- trict policies for this program. Permission slip from legal guardian required on or before day of program.


Fax Registration Form to: Mary Kirsch @ 315-332-7265 or mail to 111 Drumlin Ct., Maple Building, Newark, NY 14513


If you have any questions , please contact: Mary Kirsch, Enrichment Coordinator 315-332-7265


Wayne-Finger Lakes BOCES Enrichment Services Mkirsch@edutech.org 23


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