2024 Summer School Registration
Please fill out the form below to enroll your student up for Summer School 2024 from June 10 - 28.  If you have questions or difficulty filling out the form please contact Erin Konichek 608-624-5201 ext 219
Please Respond by May 20th. 
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Email *
Student Last Name *
Student First Name *
Grade entering 2024-2025 school year *
Is your child in-district, homeschooled, or a non-resident student? If your child is homeschool or a non-resident student, additional paperwork will be sent home with your child on the first day of summer school.
 *
Will your student need transportation *
Pick Up Location AM - if not needed write n/a
 *
Drop Off Location PM - if the same as Pick Up Location write same or if not needed write n/a
 *
Parent/Guardian Name (Contact 1)
 *
Contact 1 Relationship to Student
 *
Contact 1 Information: Cell Phone Number - if none write n/a
 *
Contact 1 Information: Work Phone Number - if none write n/a
 *
Contact 1 Information: Email - if none write n/a
 *
Contact 2:Parent/Guardian Name 
 *
Contact 2 Relationship to Student
Contact 2 Information: Cell Phone Number - if none write n/a
 *
Contact 2: Parent/Guardian Work Phone Number-if none write NA
 *
Contact 2 Information: Email - if none write n/a
 *
Doctor's Name
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Clinic/Hospital
 *
Clinic/Hospital Phone Number
 *
Medications. If medication is needed to be given during summer school, the school nurse will reach out to you for more information.
 *
Allergies or any other Health Concerns?
 *
Required
Allergies or Health Concerns-write n/a if not applicable *
Please select the Summer Learning Program the student is registering for.
 *
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