Grace Elementary Enrichment Program (GEEP) Application

General Information

I attest that the child(ren) I am enrolling today in the 'GEEP' program are currently enrolled at Rose Park Elementary

Yes

To be filled out by parent/legal guardian.

Child's Name

Date of Birth

Age

Year in School

Name of Parent/Legal Guardian

Address

Phone #1

Phone #2

This address will receive a confirmation email

Emergency Contact Information

To be used if parent/legal guardian is not available.

First Contact Name

Relationship to Child

Phone

Address

Second Contact Name

Relationship to Child

Phone

Address

Description

Thank you for your interest in GEEP! Please fill out this form and submit.