2023 Summer School Student Application

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Student First name

Student Last name

Student Current Grade Level *

Student Address *

Parent Name *

Parent 1 Cell Phone Number *

Parent 1 Work Number *

Parent 2 Name

Parent 2 Cell Phone Number

Parent 2 work phone

Emergency contact 1 Name (not parents) *

Emergency contact 1 phone number *

Emergency contact 2 (not parents)

Emergency contact 2 phone number

How will your child go home? *

Bus (if ride during regular school year)

Walk (meet under the tree at the bottom of the steps)

Parent Pick-Up (by car)

My child may have their picture taken and used on social media.

Yes

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