2023/2024 Grace Elementary Enrichment Program (GEEP) Application

Important Change to the G.E.E.P. Program

This year G.E.E.P. will only be available on Thursdays. Students are picked up directly from the school and must be picked up by 5:30 PM.

General Information

I attest that the child(ren) I am submitting an application for 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

Support Our Program

GEEP is run completely by financial support from Grace United Methodist Church. Help support this program by making a donation today!

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

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