K-4th Grade Summer School 2021- 2022
This is for registering your child for Summer School 2021-2022. K-4 Summer School will be held June 20th - July 1st from 8:30am - 3pm (Monday-Friday). Please complete form for each student that will be attending. Lunch & Snack will be provided. This form is for incoming Kinder through 4th grade. This year, we will be hosting summer school at Western Oregon University due to maintenance plans for the Elementary building. Transportation will be provided.

If you have any questions contact:
Dani Simington
dani.simington@fallscityschools.org
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Student Name *
Grade student is entering next year: *
Date of Birth *
MM
/
DD
/
YYYY
Name of Parent(s)/Guardian *
Home Phone (Best way to contact you): *
Home Address *
Contacts (if we can not get a hold of you) Name, Phone# and Relationship to Students. *
Contacts (if we can not get a hold of you) Name, Phone# and Relationship to Students. *
Has there been medical changes since school started? *
If you answered yes to the question above, please list the changes and any new medication that your child is taking with dosage information.
Does your child need transportation to and from Western Oregon University? *
I give my child permission to watch PG movie *
Required
I give my child permission to wear sunblock *
Required
I give permission to have their picture taken. *
Required
Shirt size *
Any additional information?
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