2017 Basic Skill Summer School Parent Permission Form
Basic Skills Summer School runs from June 12 through July 20, Monday through Thursday, 8:30 a.m. to noon, with no classes the week of July 3-6.

Summer School 2017 will be located at Westside Elementary School.

Parents: Please complete the below registration form (one per child) to officially enroll them into Summer School for the Summer 2017 session. Forms must be completed by Friday, March 31, 2017.

Email address *
Do you wish to enroll your child in the Basic Skills Summer School Program? *
Required
If a "No" response was given, please indicate the reason below. Also, please indicate the student's name and grade level, where requested on this form, for identification purposes.
Your answer
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student's Date of Birth (mm/dd/yy)
Your answer
Student's Current Grade Level *
Required
Student's Gender *
Required
Student's Current School *
Required
Student's Current Teacher *
Your answer
Parent/Guardian name *
Your answer
Parent/Guardian address *
Your answer
Home phone (xxx) xxx-xxxx *
Your answer
Mother's cell phone (xxx) xxx-xxxx
Your answer
Father's cell phone (xxx) xxx-xxxx
Your answer
Mother's work phone (xxx) xxx-xxxx
Your answer
Father's work phone (xxx) xxx-xxxx
Your answer
Emergency Contact name (NOT listed above.) If we cannot reach the numbers above, in an emergency, we will try to reach this person.
Your answer
Emergency Contact's relationship to student
Your answer
Emergency Contact's phone (xxx) xxx-xxxx
Your answer
If the student has any medical issues, allergies, etc. we should be aware of, please list them below *
If YES was selected above, please identify your child's medical issue
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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