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Lumberjack Learning League Enrollment Form
Please fill out the following information to enroll your child in the learning program by the deadline of May 31st, 2024.
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Date
MM
/
DD
/
YYYY
Student Name
Your answer
Your child's date of birth
MM
/
DD
/
YYYY
School your child attends
Warren High School
Warren Middle School
Clear selection
Your child's address
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian address- if different from the student's
Your answer
Parent/Guardian Phone number
Your answer
My child will attend the following session(s): Check all that applies
Before Bell ELA Boost (Mondays, Tuesdays 7:00-7:45)
Before Bell Math Boost (Wednesdays, Thursdays 7:00-7:45
After School ELA Elevate Hub (Monday, Wednesday 3:25-4:55)
After School Math Elevate Hub (Monday, Wednesday 3:25-3:55)
Extended School Year (Summer School, Monday-Wednesday 8:00-11:00- Thursday 8-3 June 10-June 28)
Transportation will be provided to and from the program. Please indicate your child's mode of transportation.
Car rider
Walker
Bus rider
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Bus Riders only: Please list your address your child will need to be dropped off at if attending the after school program
Your answer
Individuals with permission to pick my child up or check my child out
Name
Clear selection
Name of person, other than parent/guardian, authorized to act for the parent/guardian in case of emergency:
Choose
Option 1
Any allergies or medical needs:
Your answer
I understand that my child is required to participate at least 75% of the time. I have received, read, and understand the student handbook. I understand my child must attend 75% of the time in order to attend field trips.
Yes
No
Clear selection
Submit
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