Middle School Court & Net Sports Summer Enrichment Program 2021 Registration Form

This program will include court and net sports with optional field activities such as disc golf, ladder golf, ultimate Frisbee, soccer, and other team sports.

**This court & net sports program will be held in accordance with 4J School District COVID safety protocols specific to physical education.  This will Include the practice of social distancing and wearing required PPE.

Teacher:          Nathan Klarr

Dates:              Camp 1-July 28-30

                         Camp 2-August 16-18

Times:             Both Camps-9:30am-12:30pm
                         
Location:         Monroe Middle School

Grades:            6-8 (includes incoming 6th Graders and outgoing 8th Graders)

Prerequisites:  none

Camp Placement: Choose one or both camps to attend (Limit: 20 students per camp).

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Email *
Student's LAST Name *
Student's FIRST Name *
Student's 4J Identification Number
Middle School Student Will Be Attending in FA2021: *
What camp would you like to attend? *
What team sports and/or net games do you enjoy participating in? *
Student Home Address: *
Example: 200 N Monroe St., Eugene, OR 97402
Parent / Guardian Last Name: *
Parent / Guardian First Name: *
Parent/Guardian Phone Numbers - Cell, Home, Work *
Please list all available numbers.                                                                                                                                                          Examples: 541-790-7700 (Cell)   541-790-7701 (Home)   541-790-7702 (Work)
Name of Emergency Contact : *
Emergency Contact Relationship: *
Example: Grandmother, Aunt, Family Friend, etc.
Emergency Contact Phone *
Example: 541-790-7700
Health Conditions: Please indicate if any of these or other conditions apply to your child. *
Required
Please indicate if your student is supported by *
Required
As appropriate, please provide more specific information on health conditions, including required accommodations (e.g. physical limitations due to previous injury).
If the student requires prescription medication while attending this Summer Enrichment Course, please list.
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