Middle School Sewing and Textile Summer Enrichment Program 2021 Registration Form

Come explore your creative side with sewing!

This is a beginning level class, but students with some previous sewing experience are welcome to participate and build on their current skills.

Participants will get to experience both hand stitching and machine sewing in this small group, social setting.

• Use a sewing machine
• Hand sew
• Applique/patch
• Operate specialty tools
• Follow a pattern to complete project
• Design project elements

Students will be provided all materials for the course as needed.

Teacher: Katie Bushnell
Dates: August 2nd - August 5th
Times: 9:00am - 12:00pm
Location: Madison Middle School
Grades: Students going into 6th-8th grade for the upcoming school year

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Student's LAST Name *
Student's FIRST Name *
Student's 4J Identification Number
Middle School Student Will Be Attending in FA2021: *
Student Home Address: *
Example: 200 N Monroe St., Eugene, OR 97402
Parent / Guardian Last Name: *
Parent / Guardian First Name: *
Parent/Guardian Email *
Parent/Guardian Phone Numbers - Cell, Home, Work *
Please list all available numbers. Examples: 541-790-7700 (Cell) 541-790-7701 (Home) 541-790-7702 (Work)
Name of Emergency Contact : *
Emergency Contact Relationship: *
Example: Grandmother, Aunt, Family Friend, etc.
Emergency Contact Phone *
Example: 541-790-7700
Health Conditions: Please indicate if any of these or other conditions apply to your child.
Please indicate if your student is supported by
As appropriate, please provide more specific information on health conditions, including required accommodations.
If the student requires prescription medication while attending this Summer Intensive Course, please list.
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