West County Elementary 2020 Summer School Enrollment Form
** If Social Distancing Restrictions are Lifted **
Dates: June 16 - July 10 - 8:00 a.m. - 3:00 p.m.
You must complete a registration form for EACH student enrolling.
Student First Name
Student Last Name
Grade going into:
Parent/Guardian Home Telephone Number
Parent/Guardian Work Telephone Number
Name of Emergency Contact #1
Emergency Contact #1 Telephone Number
Name of Emergency Contact #2
Emergency Contact #2 Telephone Number
Check pickup at school or the bus drop off location your child will ride to:
At School Pick up - NO BUS
Leadwood (Old Middle School)
Leadwood (Warner Dr. by Wagon Wheel)
Kathy's Day Care
Wortham (1st Church of God)
Teaching Tots Day Care
Mitchell (Linda's Store)
Happy Times Day Care
Terre du Lac (Water Tower by Store)
Terre du Lac (Water Tower on double lanes of Champs Elysses Dr.)
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This form was created inside of West St. Francois County R-IV.