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West County Middle School 2020 Summer School Enrollment Form
** If Social Distancing Restrictions are Lifted **
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Dates: June 16 - July 10 - 8:00 a.m. - 3:00 p.m.
You must complete a registration form for EACH student enrolling.
Student First Name
*
Your answer
Student Last Name
*
Your answer
Grade going into:
*
6th
7th
8th
Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian Home Telephone Number
*
Your answer
Parent/Guardian Work Telephone Number
Your answer
Name of Emergency Contact #1
Your answer
Emergency Contact #1 Telephone Number
Your answer
Name of Emergency Contact #2
Your answer
Emergency Contact #2 Telephone Number
Your answer
Check pickup at school or the bus drop off location your child will ride to:
*
At School Pick up - NO BUS
Camp Irondale
Irondale (Bank)
Leadwood (Old Middle School)
Leadwood (Warner Dr. by Wagon Wheel)
Kathy's Day Care
Wortham (1st Church of God)
Teaching Tots Day Care
Mitchell (Linda's Store)
Happy Times Day Care
Terre du Lac (Water Tower by Store)
Terre du Lac (Water Tower on double lanes of Champs Elysses Dr.)
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