Name of parent/ caregiver to contact with questions or in an emergency. *
Your answer
Phone number at which parent/ caregiver can be reached. *
Your answer
Email address of parent/ caregiver. *
Your answer
An additional person & number, if the primary contact cannot be reached. *
Your answer
Please list any special accommodations that your child will need to participate in this session, if any (physical needs, allergies, etc.)
Your answer
Please let us know if there is anything else we should be aware of so that this opportunity can be a positive experience for your child.
Your answer
By signing below, I give permission for my child to attend the "Welcome to Coolidge" program, and I agree to be financially responsible for the cost of the program (but for those who require financial assistance). *
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Reading Public Schools. Report Abuse