ASH GROVE R-IV 2021 ELEMENTARY SUMMER SCHOOL ENROLLMENT FORM

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Summer School will be May 24-June 18.
Hours: 8:00 AM - 2:50 PM.
Drop off: 7:30 AM - 7:45 AM
Breakfast: 7:45 AM - 8:00 AM
Free breakfast and lunch will be served daily.
Please complete the enrollment form by Friday, April 23 if your child plans to attend summer school.
This will allow us to plan, hire an appropriate number of teachers and order needed supplies.
There will be a DAILY drawing for those in attendance. Each winner will take home a $50 gift card.
Weekly prizes will also be given away for perfect attendance.

Email *

Today's Date *

YYYY

Student Name *

Student Address *

Current Grade Level (2020-2021) *

What is your resident school district? *

Parent/Guardian Name *

Parent/Guardian Phone Number *

Best email address to use for communication during summer school. *

Emergency Contact (include name and phone number) *

You child's gender is *

Student Birthdate *

YYYY

Pirate Pals will be offered during Summer School. Do you plan to sign your child up? *

If you are signing your child up for Pirate Pals, let us know which option you will need. *

Transportation will be provided for Summer School (see locations below). Will your child be riding the bus? *

If your child will be riding the bus, which bus stop will you be using? (Choose one). Exact routes will be determined upon completion of enrollment. *

If your child does not ride the bus, how will he/she child be transported to and from school? *

Does your child have any health problems or concerns? If yes, please explain. *

Is your child allergic to anything? If yes, please explain. *

Is you child currently taking medication at school? *

Will your child need medication during summer school? *

Physician's Name, Address & Phone Number *

Hospital Preference: *

In case of accident or serious illness, I request school personnel to contact me, alternate authorized persons, or the above named physician. If it is impossible to contact me, authorized persons, or the physician, the school personnel may make emergency arrangements as necessary to care for my child. *

I will allow any pictures taken of my child during participation in summer school to be posted online and/or used in our yearbook. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Ash Grove School District. Report Abuse

Forms