2018 Elementary Summer Literacy Program Student Information Sheet
Student's Name
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Summer School Teacher's Name
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Parent/Guardian's Name
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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)
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Medical History (please inform us of any known medical concerns your child has that may affect them during the summer school program)
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Please list any Allergies
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Please add anything else you would like us to know about your child
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