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2018 Elementary Summer Literacy Program Student Information Sheet
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Student's Name
Your answer
Summer School Teacher's Name
Your answer
Parent/Guardian's Name
Your answer
Cell Phone
Your answer
Other Phone - Home/Work
Your answer
Emergency Contact/Relationship
Your answer
Emergency Contact Phone Number
Your answer
I give permission for the following adults to pick up my child: (MUST show picture ID at pick up)
Your answer
Do Not Release Concerns (please include anything we may need to know)
Your answer
Medical History (please inform us of any known medical concerns your child has that may affect them during the summer school program)
Your answer
Please list any Allergies
Your answer
Please add anything else you would like us to know about your child
Your answer
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