REGISTRATION
Spring Session of Story Port 2008
CHILD’S NAME __________________________________________________________________________________________
PARENT(S)/GUARDIAN(S) ________________________________________________________________________________
ADDRESS, CITY _________________________________________________________________________________________
PHONE NUMBER ________________________________________________________________________________________
HM/WK/CELL (circle one)
PRESENT AGE __________ GRADE ________SCHOOL ATTENDING ____________________________________________
ATTENDANCE RECORD:
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2/6 |
2/13 |
2/20 |
2/27 |
3/5 |
3/12 |
3/19 |
3/26 |
4/2 |
4/9 |
4/23 |
4/30 |
5/7 |
Total attended |
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LIST ANY ALLERGIES OR MEDICAL CONDITIONS THAT YOUR CHILD HAS:
_________________________________________________________________________________________________________
DOES YOUR CHILD NEED MEDICATION WITH THEM FOR THIS CONDITION? _________________________________
IF SO, WHAT IS THE NAME AND DOSAGE OF THE MEDICATION(S)? _________________________________________________________________________________________________________
IS YOUR CHILD ALLOWED TO LEAVE WITH ANYONE OTHER THAN YOU? YES NO (Circle one)
IF YES, PLEASE PROVIDE THE NAME(S) OF THE PERSON(S)
_________________________________________________________________________________________________________
PLEASE READ AND UNDERSTAND THE FOLLOWING CONSENT STATEMENT:
- THE PORT LIBRARY, ITS EMPLOYEES AND VOLUNTEERS ARE NOT TO BE HELD RESPONSIBLE FOR ACCIDENTS OR INCIDENTS WHICH MAY OCCUR TO THE PARTICIPANTS DURING LIBRARY PROGRAM EVENTS.
- I give permission for the use of photographs which may be taken during Story Port.
- I understand treats may occasionally be provided and my child may partake of these unless I otherwise advise in writing.
X_____________________________________________________________________ _____________________________.
EMERGENCY CONTACT NAME: TELEPHONE
X______________________________________________________________________ __________________________
PARENT’S SIGNATURE DATE
Spring 2008 Story Port Book List Feb. 6th : The Great Turtle Drive by Steve Sanfield Feb. 13th : Mike Mulligan and His Steam Shovel by Virginia Lee Burton Feb. 20th : Lu and The Swamp Ghost by James Carville Feb 27th : The Hungry Thing and The Hungry Thing Returns by Jan Slepian and Ann Seidler Mar. 5th : Wings: A Tale of Two Chickens by James Marshall Mar. 12th : Beauty and the Beaks: A Turkey’s Cautionary Tale by Mary Jan and Herm Auch Mar. 19th : A Fish Named Spot by Jennifer P. Goldfinger Mar. 26th : A Trip to Dinosaur Time by Michael Foreman Apr. 2nd : Gregory, the Terrible Eater by Mitchell Sharmat Apr. 9th : Grandpa’s Teeth by Rod Clement Apr. 16th: NO STORY PORT. No school. Apr. 23rd : Iva Dunnit and the Big Wind by Carol Purdy Apr. 30th : Aunt Minnie and the Twister by Mary Skillings Prigger May 7th : Diary of a Fly by Doreen Cronin Clipart on this page courtesy of http://www.school-clip-art.com/.