Kewaunee School District Summer School 2018
Demographic, transportation and emergency information
Please fill out a separate form for each child if registering multiple children.
Registration Deadline is May 4.
Student Name (Last, First)
Grade entering in Fall
Kewaunee Grade School
Kewaunee High School
Home school or Virtual school
Daytime phone number
Transportation: My child will
It is the parent/guardian's responsibility to transport their children to and from summer school. Please pick up and drop off your child(ren) in the drop off zone at the front entrance just like on a typical school day.
be picked up
Please list any known allergies.
Emergency Contact (name and number)
Insurance: The Kewaunee School District Summer School Program assumes no responsibility for accidents or illnesses. In the unlikely event of an emergency, please list the name and number of a person to contact if parents are not available.
Permission to Treat:
I/we the parent/guardian of said student give permission for emergency medical treatment of this child in case of illness or accident. I/we understand that the Kewaunee School District assumes no responsibility for accidents or illness. Please type initials below for signature
Never submit passwords through Google Forms.
This form was created inside of Kewaunee School District.
Terms of Service