Entering 2nd Grade - Title I Summer School Jumpstart Program

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Students who participate in the program will receive instruction emphasizing social and emotional development, cross-curricular learning in math and reading, as well as problem solving and critical thinking skills.

✅ This program will be held from MONDAY - FRIDAY 8:30 AM - 12:30 PM

✅ This program will begin on WEDNESDAY JULY 7, 2021, and run through FRIDAY JULY 30TH 2, 2021

✅ All children will be ready for dismissal promptly at 12:30 PM in the upper playground of the school.

👉 AFTER COMPLETING THIS FORM, ‼️‼️ ⭐️Please to read the confirmation you receive. 🥰

❓❓For any questions, confirmations, or concerns, please feel free to email Title I Coordinator Ms. Cobb at FESONE2@GMAIL.COM 🤗

Email *

Student Name: *

If you have more than one child, please complete a separate form for each child participating.

Will your child be joining us for this year's summer program?

Yes, I would like my child to participate in the Title One Summer School 2021 Jumpstart Program.

No, I would not like my child to participate in the Title One Summer School 2021 Jumpstart Program.

For students who walk home:

I give permission for my child to walk home.

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Emergency Contact Information

Parent (or Legal Guardian) Name: *

Parent 1 (ex. Mother)

Parent (or Legal Guardian) Cell Phone Number: *

Parent 1 (ex. Mother)

Parent (or Legal Guardian) Name:

Parent 2 (ex. Father)

Parent (or Legal Guardian) Cell Phone Number:

Parent 2 (ex. Father)

Preferred Email Address:

Home Address: *

Home Phone Number: *

#1 Emergency Contact Name & Relationship: *

The name & relationship of your emergency contact can be listed here. (ex. Jane Doe-Aunt)

#1 Emergency Contact Number: *

The name & relationship of your emergency contact can be listed here. (ex. Jill Doe-Cousin)

#2 Emergency Contact Name & Relationship:

#2 Emergency Contact Number:

Additional People to whom my child(ren) may be released:

Please enter Name, Relationship and Phone Number of additional people to whom your child may be released. You may list up to 2 additional people. (ex. Jane Doe-Aunt-1234567890, Jill Doe-Cousin-1234567890)

Parent Signature *

Please sign, initial and date form before submitting. (Ex. John Doe J.D. 6/21/19)

A copy of your responses will be emailed to the address you provided.

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