Kindergarten Camp Registration 2021

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete the form below to register your child in the Kindergarten Camp August 11, 2021.
8:00 am - 3:00 pm

School *

Child's First Name *

Child's Last Name *

Child's Date of Birth *

YYYY

Parent/Guardian Name: *

Parent/Guardian Email Address: *

Write None if you do not have an email address.

Parent/Guardian Phone Number: *

Do you accept text messages? *

Yes

Physical Address

Street Address *

City, State, Zip *

Mailing Address

* Complete if the mailing address is different from the above physical address.

Street Address

City, State, Zip

Did your child attend Lincoln County Schools' Preschool? *

Yes

If your child did not attend Lincoln County Schools' Preschool, what was the reason? *

Child did not qualify

Lack of transportation

Child attended private/home childcare

Other

Will your child be attending Kindergarten Camp? *

My child will attend Kindergarten camp and will be riding the bus.

My child will attend Kindergarten Camp and I will transport.

My child will not attend Kindergarten Camp.

Required

Consent to the School and/or District's use of my child’s directory information for various media projects. This means that your child's name or picture can be included in the yearbook, website, or newspaper. *

Yes - I consent to the School and/or District's use of my child’s directory information in various media projects.

No - I do not consent to the School and/or District's use of my child’s directory information in various media projects. This means that your child's name nor picture will be in the yearbook, website, or newspaper for any recognition.

Required

If your child is riding a bus --- please enter Bus Pick-Up Location Address below.

If your child is riding a bus --- Please enter Bus Drop-Off Location Address below.

Emergency Contact Information

Name (First & Last): *

Phone # *

Name (First & Last):

Phone #

Medical Information:

Has your child been diagnosed by a physician or receiving treatment for: *

Asthma (needs inhaler or nebulizer)

Diabetes

Heart Problems

Seizures with or without a fever

None

Other:

Required

List any allergies that your child may have:

Are any of these allergies life threatening?

Yes

Please describe allergy below:

Is your child on any daily medication that will need to be given during the school day? *

Yes

If yes above, list any medications that your child will need during the school day.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Lincoln County Public Schools.

Does this form look suspicious? Report

Forms