The Pathways to Learning 2008 Fall/Winter Program
Mendham Township Public Schools
Online Registration & Permission Form

Registration forms will be accepted via mail or online
Monday, September 29th through Wednesday, October 8th

Please use one registration form per child.

If you have any difficulties with the online registration process, please return
to the Pathways for Learning web page and print out the ‘Mail-in’ registration form.

For further information please email Sarah Witko at
pathways@mendhamtwp.org
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* Required Fields
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Date:
 September 28, 2008
Child's First Name:
 A value is required.Exceeded maximum number of characters.A value is required.Minimum number of characters not met.Exceeded maximum number of characters.*
Child's Mid. Initial:
Child's Last Name:
 A value is required.Exceeded maximum number of characters.A value is required.Exceeded maximum number of characters.*
Parent/Guardian First Name:
 A value is required.Exceeded maximum number of characters.*
Parent/Guardian Mid. Initial:
Parent/Guardian Last Name:
 A value is required.Exceeded maximum number of characters.*
Street:
 A value is required.Exceeded maximum number of characters.*
P.O. Box / Suite:
 Exceeded maximum number of characters.
City:
 A value is required.Exceeded maximum number of characters.*
Zip:
 A value is required.Invalid format.*
State:
 A value is required.*
   
For entering phone numbers please use this format (555) 555-5555
   
Parent 1 Home Phone:
 Invalid format.A value is required.*
Parent 1 Cell Phone:
 Invalid format.
Parent 1 Work Phone:
 Invalid format.
Parent 1 Work Extension:
 Invalid format.
Parent 1 Email:
 Invalid format.
   
Parent 2 Home Phone:
 Invalid format.
Parent 2 Cell Phone:
 Invalid format.
Parent 2 Work Phone:
 Invalid format.
Parent 2 Work Extension:
 Invalid format.
Parent 2 Email:
 Invalid format.
   
Emergency contacts if parent/guardian is not avaiable.
You are required to provide 3 contacts
   
Contact 1 Name:
 A value is required.*
Contact 1 Phone:
 A value is required.Invalid format.*
Contact 1 Relationship:
 A value is required.*
Contact 2 Name:
 A value is required.*
Contact 2 Phone:
 A value is required.Invalid format.*
Contact 2 Relationship:
 A value is required.*
Contact 3 Name:
 A value is required.*
Contact 3 Phone:
 A value is required.Invalid format.*
Contact 3 Relationship:
 A value is required.*
   
I would like to register my child for the following program(s):
 
Program 1:
A value is required.  *
Tuition 1 $
  *
Program 2:
 
Tuition 2 $
  
   
Total Tuition $
  
         

Parental Notification to School Official
For Participation in the Pathways to Learning Program
   
I,  *  give permission for my child A value is required* to
stay after school and participate in the Pathways to Learning Program each of the listed days of the
week A value is required. *  I,   . * also
promise to pick my child up from the class(s) he or she is registered for within the designated
time frames outlined in the parental letter and on our website and will adhere to the fee schedule if I
am not able to meet those requiremenets.
Please enter name (Digital Signature):
 A value is required*
Date:
  September 28, 2008
   
Please List the Primary Adult Responsible for Picking Up Your Child From Each Pathways Class
   

Adult Name:

 A value is required.*
  A value is reqfsdfsdDay(s) of the week:alue is required.
 A value is required.*
Acceptable Alternate Adult:A value is required.
 A value is required.*
  A value is required.Day(s) of the week:
 A value is required.*
   

Please note:  If your child will be picked up by an adult other than the names you have provided, a note needs to be sent into school with your child and given to their Pathways instructor.
   
Before submitting this form you may want to print the above form contents. After submitting the form, the data will no longer be displayed.
Final Step:


Payment may be made by check or click here to make a payment online.

Please make checks payable to: 'MTBOE Pathways Program'

Drop-off or mail checks to:
Mendham Township School District
MTBOE Pathways Program
18 West Main Street
Brookside, NJ 07926

Please note there will be no refunds of tuition or fees, for absence or
withdrawal for any reason including dismissal due to conduct.

You will be contacted with additional information after your registration form is received and confirmed.