JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Summer School 2022 Enrollment Form
Monday, May 23rd - Friday, June 24th 7:45-2:40 pm
There will be NO SCHOOL on Monday, May 30th!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student Last Name, First Name, Middle Initial
*
Your answer
Male or Female
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Grade Entering as of Fall 2022
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Home Address
*
Your answer
Current 21-22 Savannah R3 School
*
Amazonia
Helena
Minnie Cline
John Glenn
Savannah Middle School
My child does not currently attend the Savannah R3 School District
My child does not currently attend the Savannah R3 School District but will in the Fall
If your child does NOT currently attend Savannah R3, please list the school and district your child attended during the school year.
Your answer
Summer School Site your child will attend
*
Minnie Cline
John Glenn
Savannah Middle School
Parent/Guardian #1 First & Last Name
*
Your answer
Parent/Guardian #1 Relationship to student
*
Your answer
Parent/Guardian #1 Cell Phone Number
*
Your answer
Parent/Guardian #1 Work Number
Your answer
Parent/Guardian #2 First & Last Name
Your answer
Parent/Guardian #2 Relationship to student
Your answer
Parent/Guardian #2 Cell Phone Number
Your answer
Parent/Guardian #2 Work Number
Your answer
Emergency Contact-other than parent or guardian
*
Your answer
Emergency Contact-Relationship to student
*
Your answer
Emergency Contact-Best Number to contact them at
*
Your answer
Summer School Dismissal Procedures
How is your child getting home from Summer School each day?
*
Car Rider
Walker
Shuttle Bus-from Amazonia to MC/SMS ONLY
Shuttle Bus-from Helena to JG/SMS ONLY
MC/JG Car Riders ONLY-Please list your pick-up number below in other option.
I don't have a pick-up number and need one assigned to me.
Other:
Clear selection
Health Form
Does your child have an allergy to anything?
*
No
Yes- A Dr's note must be on file.
Is your child currently taking any medication at
*
Home
School -If your child needs medication during Summer School hours a medication form needs to be on site
My child is currently not taking any medication.
If your child needs to take medication at school please list the medication below.
Your answer
Please describe below any special health problems or concerns that will need to be known during SS hours.
*
Your answer
Name and phone number of students physician and hospital preference:
*
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Savannah R-III School District.
Report Abuse
Forms
