2023 Summer Advantage Application
Please complete the form below to enroll your child in our Summer School Program. All learning will be in-person, June 5th - July 12th from 8-12, Monday through Friday, for any Gallipolis City School District Students entering kindergarten -12th grade. Please complete one form for each child who will be participating. Students who successfully complete the requirements of Summer Advantage will earn incentives: 1) Backpack of school supplies, 2) up to $300 toward a shopping spree through Kohls.com 4) School Spirit T-shirt, 5) Haircut Certificate and possible other incentives. Transportation (from designated locations), breakfast, and lunch will be provided to students who attend. Applications are due by Friday, May 26th.
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Email *
Child's First Name *
Child's Last Name *
Home Address *
City *
Zip Code *
Current Grade Level (22/23 School Year) *
Current School Building (from 2022-2023 School year) *
My Child will need bus transportation to and from Summer Advantage. I understand I will need to be present at the designated pick-up and drop off location. *
Guardian's First Name *
Guardian's Last Name *
Cell Phone Number
Home Phone Number (if landline)
Work Phone Number
Parent Email Address
What is the best way to reach you? *
Required
Additional Emergency Contact Name (if parent can not be reached)
Emergency Contact Phone Number
Allergies-List below
Medications-List below
Medical Issues-List those we need to be aware of
MIDDLE & HIGH SCHOOL STUDENTS ONLY-Mark only those that apply to your child
Student's T-Shirt Size *
PLEASE READ THE STATEMENT BELOW AND TYPE YOUR NAME TO ATTEST YOUR CHILD'S PARTICIPATION:   I understand my child will be provided materials and will actively participate in ONSITE learning from June 5 - July 12, Monday through Friday. I understand to earn incentives (clothing, shoes, backpacks, haircut certificate, t-shirt, etc...) that my child must actively participate and attend 21 out of 25 days to meet the 85% attendance requirement.
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