PSO Summer String Fling 2019 Registration
Please fill out a separate registration form for each student.
Student Name, First-Last
Parent Name, First-Last, Primary Contact
Parent Phone, Best Number (No dashes required)
Emergency Contact Name and Best Number (No dashes required)
Student Home Address
Student Date of Birth
Student School & Grade, 2018-19 School Year
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.)
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.)
Student Shirt Size, please select 1
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