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Super Summer Enrollment - May 27-June 26
Questions? Contact Jason Vieselmeyer (417-625-5270) or Chris Bozarth (417-625-5320)
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Student Name
*
Your answer
Date of Birth
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MM
/
DD
/
YYYY
Parent/Guardian Name
*
Your answer
Phone Number
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Your answer
Address
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Your answer
Parent's Email
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Your answer
Incoming Grade
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6th
7th
8th
Current School
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Cecil Floyd
Jefferson
West Central
Irving
Stapleton
McKinley
Royal Heights
Columbia
Soaring Heights
Eastmorland
Kelsey Norman
North Middle School
South Middle School
East Middle School
Medical Needs/Medications Taken
*
Your answer
How will your child get to and from Super Summer?
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Bus
Car Rider
I give permission for my child to attend field trips.
*
Yes
No
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