Summer School 2021 Enrollment Form
Monday, May 24th - Friday, June 25th 7:45-2:40 pm
There will be NO SCHOOL on Monday, May 31st.
Email *
Student Last Name, First Name, Middle Initial *
Male or Female *
Date of Birth *
MM
/
DD
/
YYYY
Grade Entering as of Fall 2021 *
Home Address *
Current 20-21 Savannah R3 School *
If your child does NOT currently attend Savannah R3, please list the school and district your child attended during the school year.
Summer School Site your child will attend *
Parent/Guardian #1 First & Last Name *
Parent/Guardian #1 Relationship to student *
Parent/Guardian #1 Cell Phone Number *
Parent/Guardian #1 Work Number
Parent/Guardian #2 First & Last Name
Parent/Guardian #2 Relationship to student
Parent/Guardian #2 Cell Phone Number
Parent/Guardian #2 Work Number
Emergency Contact-other than parent or guardian *
Emergency Contact-Relationship to student *
Emergency Contact-Best Number to contact them at *
Summer School Dismissal Procedures
SACC will NOT be offered after school this summer!
How is your child getting home from Summer School each day? *
MC/JG Car Riders ONLY-Please list your pick-up number below in other option.
Clear selection
Health Form
Does your child have an allergy to anything? *
Is your child currently taking any medication at *
If your child needs to take medication at school please list the medication below.
Please describe below any special health problems or concerns that will need to be known during SS hours. *
Name and phone number of students physician and hospital preference: *
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