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About Portledge >  Summer Adventures >  Registration >  Reg_Form > 

Summer Adventures Online Registration Form

1st Child
*First Name
*Last Name
Nickname
*Date of birth
 
*Gender
 Female  Male
*Current School
*Current Grade
As of September 2011.
PN=13, N=14, PK=15, K=16
2nd Child
*First Name
*Last Name
Nickname
*Date of birth
 
*Gender
 Female  Male
*Current School
*Current Grade
As of September 2011.
PN=13, N=14, PK=15, K=16

Parent's
*Parent 1: First name
*Parent 1: Last name
*Parent 1: e-mail
Parent 1: Cell phone
Parent 2: First name
Parent 2: Last name
Parent 2: e-mail
Parent 2: Cell phone

Home Address
*Home phone
*Address
*City
*State
*Zip
*Password
Please enter a password to enable your speedy access to the program selection section. Your email address will be your username.
  • Deposits are non-refundable.
  • No refund will be made for days missed and/or withdrawal from the program.
  • A medical form will be mailed with your confirmation of registration.
  • A copy of your child’s immunization records must be on file prior to the start of any program.
  • Permission is granted for this child to engage in all program activities except as noted on child’s health form.
  • Permission is granted for the campus nurse or certified staff to perform first aid in case of an emergency.
  • Permission is granted to use any photos in connection with publicity for Portledge School including Portledge Summer Adventures.
  • Portledge is not responsible for any lost or stolen personal items.
  • Portledge recommends that valuable personal items not be brought on campus.

Please complete program selection form found here.

Portledge School
Summer Adventures
355 Duck Pond Road, Locust Valley, New York 11560
www.portledge.org/SummerAdventures
SummerAdventures@portledge.org
Program (516)750-3104
Fax (516) 671-2039

© 2011 Portledge School I 355 Duck Pond Road I Locust Valley, NY 11560 I 516.750.3100
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