CLEMENTE MS
WINTER 2015 ACTIVITY SIGN UP SHEET
January 12 - March 12
Please return this registration form between 8:00 am on December 2 until 4:15 pm on December 4 to the EBB mailbox in the main office.
BOTH sides must be completed. Registration forms will be accepted on a first come, first served basis during this time.
Requests submitted after December 4th at 4:15 will not be processed until all of the requests submitted before the deadline have been first processed.
Student’s Name (Last, First) _______________________________________________________________________________
Student ID# ______________________________________________________________ Grade _____________________
I will be participating in a school club (Sports, Yearbook, etc.) on:
☐Monday
CHOOSE EITHER 1
☐Tuesday
3:15pm-5:15pm block
☐Wednesday
☐Thursday
DIRECTIONS
OR 2 3:15pm-4:00pm & 4:15pm-5:15pm blocks (select 1 program from each block)
If you sign up for a 4:15 – 5:15 EBB class, you must sign up for a 3:15-4:15 EBB class or be in a school club.
2:45-3:15
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
Meal
__TOS Musical Theater
Workshop: Sing, Dance, Act
__Total Girl
__One Sisterhood STEP Team
__EBB Youth Advisory
Committee (YAC)
Meal
__ClancyWorks Dance : ASPIRE
__Young Chefs: Cooking
__Hair Design
__AOB:Visual Storytelling
Meal
__So What Else?:
Environmental program
__Hip Hop Dance
Meal
__FutureMakers: STEM
__Taste and Move: Cooking
__Hip Hop DJ Skills
3:15-4:00
__Shooting Stars
__Hoop Ed:Team Sports
__Shooting Stars
__Shooting Stars
__Math Ninjas
__Shooting Stars
__STEM Academy: Robotics
4:15-5:15
__Shooting Stars
__Hoop Ed:Team Sports
__Shooting Stars
__Sports and Fun
__Shooting Stars
__Sports and Fun
__Math Ninjas
__Shooting Stars
__Sports and Fun
__STEM Academy: Robotics
3:15-5:15
1
2
2
Montgomery County Government is committed to compliance with the Americans with Disabilities Act (ADA).
To facilitate inclusion, interpreters, large print or Braille auxiliary aids and/or services should be requested at the time of registration.
Please Select One:
☐ Ride the activity
bus at 5:25
☐ Walk home
☐ Parent/Guardian
will pick up at 5:25
☐ Public Transportation
ACTIVITY BUSES LEAVE EACH DAY AT 5:25.
If you have any questions, please call the Site Coordinator, Seantae Jones, at 240-478-1412.
Official Use: Received:______________