Summer Learning Exploration 2019 Registration Form
FORM MUST BE FILLED OUT BY MAY 31, 2019.
Site: Emmons Elementary School - 1306 South Main Street, Mishawaka, Indiana 46544
Transportation: Provided to and from your child's home school (refer to the bus schedule)
Dates: June 24 - July 24 (M-F) NOTE: No camp on July 4 and 5
Time: 8:30 AM - 3:00 PM
Meals: Breakfast and lunch will be provided
Fee: $20 Materials Fee
STUDENT AND PARENT/GUARDIAN INFORMATION
Student Name
Your answer
Gender
School Currently Attending
Current Grade (for 2018-19 school year)
Parent/Guardian Name
Your answer
Home Address
Your answer
City and Zip Code
Your answer
Phone Number
Your answer
Does Student have an IEP?
My Child Will Be Attending:
$20 Materials Fee:
TRANSPORTATION
My child will be riding the bus to and from their home school
MEDIA CONSENT
Your child's school often has opportunities for positive media coverage. Staff of School City of Mishawaka and United Way may want to review, photograph, or videotape your child and/or their work for publications, television reports, public presentations, websites, and social media. Student work and information includes but is not limited to: child's photo; name; grade; age; drawings; materials; writings and/or quotations; photographs; and images.
Media Release Consent
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