JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
3rd, 4th, 5th Grade LIPI
Parents,
Use this form to let us know that your student is planning to attend this LIPI
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student Name
Your answer
Name of Parent Guardian filling out this form
Your answer
Grade Level
3rd
4th
5th
Clear selection
While my child is at LIPI, a parent-guardian can be reached at this phone number:
Your answer
After LIPI my student will
get home by themselves
I will pick them up
Someone else will pick them up (please use the comment section to name who will pick up your child)
Clear selection
I understand that in order to participate, my student must wear a face covering over their nose and mouth at all times and adhere to 6 ft of social distance with everyone at school. If they do not have a face covering, one will be given to them.
Yes
No
Clear selection
I understand that students will participate outside, rain or shine and will make sure to dress appropriately. I understand that depending on weather, staff may decide to take students inside the building.
yes
No
Clear selection
Comments, Questions
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Portland Public Schools.
Report Abuse
Forms
