SUMMER SCHOOL REGISTRATION
June 14 —July 22, 2016
Please register by June 1, 2016
Student’s Name
Parent’s Name
Address
Phone
Please circle your response to the following:
Grade Child was in during the 2015—2016 school year. Pre-K K 1 2 3 4 5 6
Emergency Contact Information:
Name:
Phone:
Address:
Relationship
Doctor:
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 for 30 minutes, 3 times per week. Send tennis
shoes to school for the 6 weeks that can stay here for the summer. Flip flops will not be
allowed.
Return to the Litchfield School office or Mrs. Sadler as soon as possible.
Classes will be June 14—July 22, 2016
Hours: 8:30—12:00 Monday through Friday
School Phone: 308-446-2244
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