Summer Journey 2026 Registration Form

May 19th-May 22nd: Tuesday-Friday

May 26th-May 29th:  Tuesday-Friday

June 1st-June 5th: Monday-Friday

June 8th-10th: Monday-Wednesday. We will NOT be in session the 11th or 12th. (Fair week)

June 16th-19th:  Tuesday-Friday

Times: 8:00-3:00 (Doors open at 7:30) 
Enrollment Closes May 3rd
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Email *
Student's First Name *
Student's Middle Name *
Student's Last Name *
Student's Birth Date *
MM
/
DD
/
YYYY
Student's Grade Level for the Fall of 2026-27 School Year *
Student's Physical Address including city, state, and zip code *
Student's Mailing Address (if different) including city, state, and zip code
Parent/Guardian 1 - Name and Cell Number *
Parent/Guardian 1 - Alternative Phone Number
Parent/Guardian 1 - Email  *
Parent/Guardian 2 - Name and Cell Number *
Parent/Guardian 2 - Alternative Number
Parent/Guardian 2 - Email 
Emergency Contact (other than listed above) Name & Number  *
Ethnicity  *
Gender *
Current School Name *
AM Transportation *
IF AM Bus, please list address of pick up. If car, mark NA.  *
PM Transportation *
IF PM bus, please list address of drop off. If car, mark NA.  *
Health problems or concerns. *
If yes, please describe.  If no, mark NA *
Is your child currently taking medication at school?  *
If yes, List Drug(s). If no, mark NA.  *
Is your child allergic to anything? *
If yes, please identify. If no, mark NA.  *
Will your child need medication during Summer School? *
Name and phone number of physician(s). *
In case of accident or serious illness, I request school personnel to contact me, alternate authorized person(s), or the named physician.  If it is impossible to contact me, authorized persons, or physician, the school personnel may make emergency arrangements as necessary to care for my child.  *
Hospital Preference *
I will allow any pictures taken of my child during summer school to be posted on the school's social media.  *
My typed signature is my written permission for my child to attend Osage County R-II Summer Journey Program.  *
Do you plan to enroll your child in swim lessons? 
1st grade and up. *LIMITED SPOTS AVAILABLE-FIRST COME FIRST SERVED*
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