LHS Summer Clinic Registration, WAIVER, RELEASE AND ASSUMPTION OF RISK (Parent)

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

This form MUST be filled out PRIOR to your student attending LHS Summer Clinics.

Email *

Please Complete One Form for each Child

Student First Name *

Student Last Name *

Student ID # *

Student Qualified for Free/Reduced Lunch during the 23-24 School Year
**Free/Reduced Lunch Program Rate is a Flat $5 per clinic (1-2 days) or $10 per Clinic (3+ days).
*

Yes

Grade for the 2024-25 school year *

School the student will attend during the 24-25 school year? *

Emergency Contact Name *

Emergency Contact Phone # *

Clear form

Never submit passwords through Google Forms.

This form was created inside of Lincoln Public Schools. Report Abuse

Forms