George West Elementary School 2024 SUMMER ACE Enrollment Form
Dear Parents/Guardians,

Please complete the entire Enrolment Form for the 2024 SUMMER ACE Program. This will ensure we maintain accurate records for student safety and for reporting requirements. We look forward to a great summer with your child. Thank you!
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Student First Name: *
Student Middle Name:
Student Last Name: *
Gender *
Date of Birth: *
MM
/
DD
/
YYYY
Physical Address: *
Grade Level: *
Parent/Guardian #1 Information:

(Last, First Name)
 *
Relationship: *
Cell Phone: *
Home/Work Phone:
Email:
Parent/Guardian #2 Information: 

(Last, First Name)
Relationship:
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Cell Phone:
Home/Work Phone:
Email:
Emergency Contact Information:

Name and Phone Number:
 *
Emergency Contact Information:

Name and Phone Number:
 *
Emergency Contact Information:

Name and Phone Number:
Transportation Arrangements:

This student will:
 *
Required
ADULTS AUTHORIZED TO PICK UP STUDENT:

Please include:
Name
Number 
Relationship


 *
  ADULTS AUTHORIZED TO PICK UP STUDENT:

Please include:
Name
Number 
Relationship


Medical Information:

Is there any medical reason why this child shall not participate in physical activities?
 *
If yes, please explain:
Please list any medical concerns:
Please list any allergies:
My child takes the following medications daily:
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