Small Town Times
May 2018
SUMMER SCHOOL REGISTRATION
June 11 —July 20, 2018
Please register by June 1, 2018
Student’s Name:___________________________________________________________
Parent Name:_____________________________________________________________
Address: _________________________________________________________________
Phone Number: ___________________________________________________________
Grade child was in during the 2017-2018 School Year: (circle one) PK K 1 2 3 4 5 6
Emergency Contact Information:
Name:______________________________ Relationship: _______________________
Phone: _____________________________ Doctor:_____________________________
Address: ____________________________ Town:_____________________________
My child ay 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 11—July 20, 2018 (No school 4 th of July)
Hours: 8:30—12:00 Monday through Friday
School Phone: 308-446-2244
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