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
• 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:
Arts and Technology Academy
Cal Young Middle School
Kelly Middle School
Kennedy Middle School
Eugene Online Academy
Madison Middle School
Monroe Middle School
Roosevelt Middle School
Spencer Butte Middle School
Student Home Address:
Example: 200 N Monroe St., Eugene, OR 97402
Parent / Guardian Last Name:
Parent / Guardian First Name:
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
Health Conditions: Please indicate if any of these or other conditions apply to your child.
Asthma (please list more specific information below)
Diabetes (please list more specific information below)
Heart Condition (please list more specific information below)
Hearing Loss (please list more specific information below)
Orthopedic Condition (please list more specific information below)
Mobility Limitation (please list more specific information below)
Severe Bee Sting (please list more specific information below)
Seizures (please list more specific information below)
Severe Food Allergy (list which food or foods below)
Speech Disorder (please list more specific information in prompt below)
Other Allergies (please list more specific information in prompt below)
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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