ASH GROVE R-IV 2023 ELEMENTARY SUMMER SCHOOL ENROLLMENT FORM

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Summer School will be Tuesday, May 30- Friday, June 23.
Hours: 8:00 AM - 3:05 PM.
Free breakfast and lunch will be served daily.
Please complete the enrollment form by Friday, April 21st if your child plans to attend summer school. This will allow us to plan, hire an appropriate number of teachers, and order needed supplies. There will be a WEEKLY drawing for those in attendance. Students have a chance to take home prizes for perfect attendance.

Please note: this form will need to be filled out for each child.

Email *

Today's Date *

YYYY

Student First Name *

Student Last Name *

Student Address *

Current Grade Level (2022-2023) *

What is your resident school district? *

Parent/Guardian Name *

Parent/Guardian Phone Number *

Best email address to use for communication during summer school. *

Emergency Contact (include name and phone number) *

You child's gender is *

Student Birthdate *

YYYY

Transportation will be provided for Summer School (see locations below). Will your child be riding the bus? *

If your child will be riding the bus, which bus stop will you be using? (Choose one). Exact routes will be determined upon completion of enrollment. *

Pirate Pals ( a fee based before and after school care program) will be offered during Summer School. Do you plan to sign your child up? *

If you are signing your child up for Pirate Pals, let us know which option you will need. *

If your child does not ride the bus, how will he/she child be transported to and from school? *

Does your child have any health problems or concerns? If yes, please explain. *

Is your child allergic to anything? If yes, please explain. *

Is you child currently taking medication at school? *

Will your child need medication during summer school? *

Hospital Preference: *

In case of accident or serious illness, I request school personnel to contact me or the emergency contact. If it is impossible to contact me or the emergency contact, the school personnel may make emergency arrangements as necessary to care for my child. *

I will allow any pictures taken of my child during participation in summer school to be posted online and/or used in our yearbook. *

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