CCCMS Summer 2024 Programming Sign-Up

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Please fill out the form below for our middle school summer program. One form per child. Thank you! We will need at least 10 students signed up in order to host the week of learning. Filling out the form indicates you enrollment in the week long program: June 10-13th 8:30am to 3:30pm at CCCMS.

Email *

Record my email address with my response

Student Last Name: *

Student First Name: *

Grade student was in for 2023-2024 *

Parent(s)/Guardian(s) Name: *

Parent/Guardian Email: *

Phone contact for Parent(s)/Guardian(s): *

Summer home address: *

Emergency Contact(s) if parent/guardian cannot be reached: (Name and Phone Number) *

Does your child ride a country bus route during the school year? *

Yes

Any health concerns, allergies, medications, etc. that we need to be aware of?

A copy of your responses will be emailed to .

Submit

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