School Year 2008-2009
Please print this form, fill out, and send to
K2 Enrichment Program
Peter Wong
6 Olive St
Brighton, MA 02135
Check the sessions(s) you would like to enroll your child .
Session 1 Tues Wed Thur Sat
Sept 9-Oct 23 (7 wks) _ $315.00 _ $315.00 _ $315.00 _$315.00
Session 2 Tues Wed Thur Sat
Oct 28-Dec 18 (7 wks) _ $315.00 _ $315.00 _ $315.00 _ $315.00
Session 3 Tues Wed Thur Sat
Dec 16-Feb 26 (7 wks) _ $315.00 _ $315.00 _ $315.00 _ $315.00
Session 4 Tues Wed Thur Sat
Feb 10-April 16 (7 wks) _ $315.00 _ $315.00 _ $315.00 _ $315.00
Session 5 Tues Wed Thur Sat
April 7-June 18 (7 wks) _ $315.00 _ $315.00 _ $315.00 _ $315.00
Total Program Fees Due: ___________
One-time $15 non-refundable Application Fee for each child.
Today's Date: _____________________________________________
Grade: _______________ School:______________________________
Child's Name: _____________________Date of Birth: ___/_____/_____
Parents/Guardians: _________________________________________
Home Address: ____________________________________________
(Street) (City) (Zip)
Home Phone __________________ Cell Phone: _________________
Work phone __________________ E-mail: ______________________
Please note medical history (allergy) /special needs: _________________________ ________________________________
_________________________________________ ________________
Does your child take any medications? ? No ? Yes ____________ ____
_____________________________________________________ ____
_____________________________________________________ ____
Additional Comments: _________________________________________________________
_____________________________________________________ ____
Payment Enclosed: ______________________________
(Please make all checks payable to Peter Y. Wong, LLC )
*Dates and fees are subject to change.