LET'S READ REGISTRATION

“LET’S READ” SUMMER TUESDAYS

FOR YOUTH

Includes those entering 7th-9th grades

Tuesdays: June 9 – August 11, 1:00-3:00 PM

Reading & Recreation

Fee: $45.00

NAME: ­­­­­­­­­­­­­­________________________________________________GRADE IN FALL: ___________

PRIMARY MAILING ADDRESS:

________________________________________________________________________________

PRIMARY FAMILY EMAIL: __________________________________________________________

FATHER’S NAME: _______________________________ PHONE #_________________________

MOTHER’S NAME _______________________________ PHONE # _________________________

EMERGENCY CONTACT INFORMATION:

NAME:_________________________________________ PHONE #_________________________

PARENT SIGNATURE: ____________________________________ DATE: __________________

Notes: (allergies, etc) ­­­­­­­­­­­­­­­­­­­­­­­_________________________________________________

_______________________________________

SNACKS