PANTHER SUMMER SCHOOL ENROLLMENT FORM
NORTH PLATTE ELEMENTARY SCHOOL-CAMDEN POINT, MO

May 24th – June 22  GRADES K- 8 (Fall Grades)

For Questions Contact Kellie Goodlet (kellie.goodlet@nppanthers.org) or Kelly Downing (kelly.downing@nppanthers.org)

******COMPLETE ONE FORM PER STUDENT******

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Student's Name *
Date of Birth *
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DD
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Grade Level for Fall of 2022 School Year *
Parents'/Guardians' Names (First and Last Names) *
Full Address *
Daytime Phone Number *
Cell Number
Work Number
Required emergency contact person other than a parent with phone number in case of emergency if a parent cannot be reached. *
Please indicate what your child will be doing in the morning for transportation. APPROXIMATE pick up time are noted below. *
Required
Please indicate what your child will be doing in the afternoon for transportation. APPROXIMATE drop off times are noted below. *
Required
Person(s), non-parental, authorized to pick-up student from Summer School
Please list any health information (If no concerns please enter "None") *
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