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.
Email address *
Student Name (Last, First) *
Your answer
Age *
Your answer
Grade entering in Fall *
School Attending: *
Parent/Guardian Name(s) *
Your answer
Email address *
Your answer
Daytime phone number *
Your answer
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.
Allergies
Please list any known allergies.
Your answer
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.
Your answer
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
Your answer
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