SUMMER SCHOOL REGISTRATION
June 12 —July 21, 2017
Please register by June 1, 2017
Student’s Name
Parent’s Name
Address
Phone
Please circle your response to the following:
Grade Child was in during the 2016—2017 school year. Pre-K K 1 2 3 4 5 6
Emergency Contact Information:
Name:
Relationship
Phone:
Doctor:
Address:
Town
My child may be released to the following individuals:
My child MAY NOT be released to the following individuals:
Please list any special instructions or helpful information about your child:
(For example: food allergies, fears, special interests, etc.)
We will be working with the Greenhouse this summer. The flowers pots
downtown have been beautiful. We will be watering them at least twice a week.
Return to the Litchfield School office or Mrs. Sadler as soon as possible.
Classes will be June 12—July 21, 2017 (No school 4 th of July)
Hours: 8:30—12:00 Monday through Friday
School Phone: 308-446-2244
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