2021 Kinder Camp Student Registration
Please provide information needed to process your child's invitation for Kinder Camp.
Email *
Student's Last Name *
Student's First Name *
Student's Date of Birth (MM/DD/YY) *
Parent/Guardian's Name *
Parent/Guardian's Best Contact Phone Number *
Parent/Guardian's Work Phone Number *
Please list 2 adults (other than parent/guardian listed above) who may meet your child at the crosswalk or pick up your child in the car line. (List Names/Phone Numbers) NOTE: Your child will not be released to anyone else without prior arrangement with the school's administration. A photo ID must be provided. *
NOTE: An Emergency Contact must provide a photo ID to pick up your child.
Emergency Contact #1 Name/Relationship *
Emergency Contact #1 Phone Number *
Emergency Contact #2 Name/Relationship *
Emergency Contact #2 Phone Number *
Home Address *
How will your child get to Summer Learning Camp? (Please select all that apply.) **Please note: Bus transportation cannot be guaranteed for applications received after June 14th. *
Daycare provider's name and phone number, if applicable.
Select the day(s) the daycare provider will pick up your child.
Individual arrangements for administering medication must be made at each school. Medication and medication authorizations must be brought to your child’s Kinder Camp site before July 12-15. All unused medication must be picked up by a parent/guardian by August 2, 2021. (Medication authorizations are valid for the summer session).
Please check all that apply. *
If you checked one of the first 5 boxes above, please explain.
Physician's name and phone number.
Dentist's name and phone number.
In case of an emergency, 911 will be contacted followed by a phone call to the parent/guardian. The school will make necessary arrangements to provide emergency care and treat for your child. This may include transportation to and treatment at a hospital or medical facility as recommended by appropriate emergency medical personnel. The School Board does not assume responsibility of payment for such services rendered.In the case of an accident or illness where immediate treatment of your child is not indicated, but where he/she is unable to remain on campus, the school will contact you or your emergency contact to arrange transportation of your child. If the school is unable to contact you or your designated emergency contact, the school will take such action as is necessary for the safety of your child.
Acknowledgement: * I acknowledge that the information provided is accurate to the best of my knowledge. *
My child has permission to participate in the use of the Reading Eggs program. *
A copy of your responses will be emailed to the address you provided.
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