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Summer SHINE Registration
Help us BUILD a fun summer by filling out one form per student!
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* Indicates required question
Email
*
Your email
PARENT/GUARDIAN INFORMATION
PARENT/GUARDIAN Name (first and last)
*
Your answer
Home Address
*
Your answer
Phone Number
*
Your answer
Can we text this number?
*
Yes
No
STUDENT INFORMATION
One form per student is required.
STUDENT name (first and last)
*
Your answer
Please list any allergies or medical issues we should be aware of. If medication or an epipen is required, please contact the SHINE director.
Your answer
What grade is this student entering for the 2023-2024 school year?
If this has not been decided, please choose their current grade.
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
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