Summer School Enrollment 2019

Summer School Enrollment 2019

EAST NEWTON R-VI SUMMER SCHOOL ADVENTURE

Enrollment Form


Student Information (Please fill form out completely for each child)

Legal Name (Last, First, Middle): 

Current Grade:     Campus: 

Homeroom Teacher: 

Date of Birth:            Gender: 

Mailing Address: 

Physical Address (if different than mailing address): 

Parents/Guardians: 

Home Phone #: 

Mother's Cell Phone:    Father's Cell Phone: 

Mother's Work Phone:    Father's Work Phone: 


EMERGENCY CONTACT(other than parent/guardian)

Name: 

Home Phone:  Work Phone:  Cell Phone: 

Name: 

Home Phone:  Work Phone:  Cell Phone: 

TRANSPORTATION

Please take time to review the routes and choose which route would be most suitable for your child.  If you have any questions please feel free to call Mr. Jason White at the transportaton office at 417-472-3922. 

Student will be: 

**If riding a bus please select a bus route from the following options.

Click for route details: Granby   Triway

Granby

Triway:  

Evening Bus Route if different than morning: 

Comments: 

 


In the event of an accident or an emergency situation, I request that the school call me or contact one of the emergency contacts listed above. 

Parent/Guardian Signature: 



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