2021 Longwood ENL Summer Program Application & Medical Form
All Longwood English language learners are invited to the ENL Summer Program.

The 5-day program is scheduled from 9:00 a.m. to 3:00 p.m. (no program on Friday, July 30)
1. Tuesday, July 27
2. Wednesday, July 28
3. Thursday, July 29
4. Monday, August 2
5. Tuesday, August 3

Each day begins and ends at Longwood Middle School, 41 Yaphank Middle Island Road, Middle Island.  Students entering 7th-12th grade will go to Longwood Junior High School or Longwood High School for their activities after arrival to the middle school.  School bus transportation is provided and breakfast and lunch will be served each day at no cost.

Students will strengthen their English, leadership and social skills through computer science activities.  

To enroll your child, please complete and return the enclosed emergency/enrollment form immediately.  If you need help, call 631-345-9282 between 8am-2:30 (Monday-Friday) for assistance.  Please leave a message if we don't answer; we will call you back.

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Email *
Student First Name *
Student Last Name *
Student Home Address: *
Grade in school this year (2020-21) *
If K-4, which school does your child attend?
Best cell phone number:  (If home phone, please note)
Will your child ride the school bus? *
Father's Full Name:
Father's Cell Phone:
May we contact you with a text message on above cell phone?
Father's Work Phone:
Email Address:
Mother's Full Name:
Mother's Cell Phone:
May we contact you with a text message on above cell phone?
Mother's Work Phone:
Email Address:
1st Emergency Contact's Name & Phone Number:
2nd Emergency Contact's Name & Phone Number:
Primary Doctor's Name & Phone Number:
Family Dentist's Name & Phone Number:
Does your child have a vision problem? *
Required
Does your child have a hearing problem? *
Required
MEDICAL EMERGENCY: Please provide the following medical information. It is essential that this information be complete. *
Yes
No
Convulsions / Epilepsy
Heart Condition
Diabetes
Asthma
Food Allergies
Medicine Allergies
If you answered YES to any condition above, please list medication(s) that may be used in an emergency:
Medical Emergency: Bee Stings (indicate type of reaction your child may have to a bee sting) *
Required
Does your child take any other medications? *
If yes, what is the reason for the medication and the name of the medication:
In the event that my child requires medical care from a physician or emergency care staff, I grant permission for school officials to seek such help and I will assume responsibility for costs incurred due to the emergency (ambulance, emergency room, physician, etc.)  By typing your first and last name below, you are signing this document. *
A copy of your responses will be emailed to the address you provided.
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