LET'S READ REGISTRATION

“LET’S READ” SUMMER TUESDAYS

FOR YOUTH

Dates to be announced ...

NAME: ­­­­­­­­­­­­­­________________________________________________GRADE IN FALL: ___________

PRIMARY MAILING ADDRESS:

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PRIMARY FAMILY EMAIL: __________________________________________________________

FATHER’S NAME: _______________________________ PHONE #_________________________

MOTHER’S NAME _______________________________ PHONE # _________________________

EMERGENCY CONTACT INFORMATION:

NAME:_________________________________________ PHONE #_________________________

PARENT SIGNATURE: ____________________________________ DATE: __________________

Notes: (allergies, etc) ­­­­­­­­­­­­­­­­­­­­­­­_________________________________________________

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SNACKS