CLEMENTE MS
FALL 2014 ACTIVITY SIGN UP SHEET
September 29- December 11
September 16 at 3:00PM is the deadline to turn in BOTH sides of this completed registration to the EBB mailbox in the main office.
Registration forms are randomly selected. The activities you select below determine your program placement.
Student’s Name (Last, First) _______________________________________________________________________________
Student ID# ______________________________________________________________ Grade _____________________
I will be participating in a school based program or club (Sports, Yearbook, etc.) on:
☐Monday
☐Tuesday
☐Wednesday
☐Thursday
If you are in EBB and are taking a school based activity until 4:15, you must sign up for a 4:15-5:15 EBB class.
CHOOSE EITHER 1
3:15pm-5:15pm block
MONDAY
2:45-3:15
DIRECTIONS
OR 2 3:15pm-4:00pm & 4:15pm-5:15pm blocks (select 1 program from each block)
TUESDAY
Hot Supper
WEDNESDAY
Hot Supper
THURSDAY
Hot Supper
Hot Supper
3:15-5:15
__ClancyWorks Dance: ASPIRE __Young Chefs:Cooking
__AOB: Mosaics
__Hair Design
__The Total Girl
__One Sisterhood STEP Team
__Math Ninja
__Hip Hop Dance
__So What Else?: Taste & Move
__ Hip Hop DJ Skills
__STEM Academy
__Creativity to Cash
3:15-4:00
__Shooting Stars (A)
__Hoop ED: Team Sports
__Shooting Stars (C)
__So What Else?:
Rhythm Harmony Dance
__Shooting Stars (E)
__So What Else?:
Environmental Program
__Shooting Stars (G)
__ Nu You: Teen Esteem
__Shooting Stars (B)
__Hoop ED: Team Sports
__Shooting Stars (D)
__So What Else?:
Rhythm Harmony Dance
__Shooting Stars (F)
__So What Else?:
Environmental Program
__Shooting Stars (H)
__ Nu You: Teen Esteem
1
2
2
4:15-5:15
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 at 240-478-1412.
Official Use: Received:______________
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.