PSO Summer String Fling 2019 Registration
Please fill out a separate registration form for each student.
Email address *
Student Name, First-Last *
Your answer
Parent Name, First-Last, Primary Contact *
Your answer
Parent Phone, Best Number (No dashes required) *
Your answer
Emergency Contact Name and Best Number (No dashes required) *
Your answer
Student Home Address *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Student School & Grade, 2018-19 School Year *
Your answer
Allergies or Prescribed Medication *
Does your child have any allergies or take any prescribed medication about which we should be aware?
List Allergies or Prescribed Medications: (If any allergies or prescribed medication, please have Authorization for Severe Allergy, Emergency Medical Care or Prescribed Medications forms completed by a doctor.)
Your answer
Special Needs: (If your child has any special needs including 504 or IEP, medical conditions, or severe allergies that are not self-managed and warrant special care or instructions, please call Executive Director, Lisa Bayer 810-624-0257 a minimum of 1 week prior to the start date of the program to discuss.)
Your answer
Student Shirt Size, please select 1 *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service