Summer Academy Registration

STUDENT INFORMATION
Student First Name*
Student Last Name*
Student Date of Birth*
Month
Day
Year
School Name*
Where is the student currently attending school?
REGISTRATION INFORMATION
Your student will attend Summer Academy at:
AUDUBON ELEMENTARY SCHOOL
Your student will attend Summer Academy at:
PRESCOTT ELEMENTARY SCHOOL
Your student will attend Summer Academy at:
TABLE MOUND ELEMENTARY SCHOOL
Registration Option*
Student is registering for:
- Full-Day Option
- Morning Only

PARENT / GUARDIAN INFORMATION
Parent/Guardian First Name*
Parent/Guardian Last Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email
Primary Household Phone*
Cell Phone
Work Phone
EMERGENCY CONTACT INFORMATION
Emergency Contact #1 First and Last Name*
Emergency Contact #1 Phone*
Emergency Contact #2 First and Last Name*
Emergency Contact #2 Phone*

ARRIVAL INFORMATION
Arrival Transportation*
FREE transportation on the district's yellow school buses will be available from express stops at area schools in the morning before the program begins.
- Drop-Off
- School Bus Transportation
Name of Person Dropping Student Off at 8:15 a.m.
Audubon Morning Express Route
Prescott Morning Express Route
Table Mound Morning Express Route
DEPARTURE INFORMATION
Name of Person Picking Student Up at 12:05 p.m.
Departure Transportation
FREE transportation on the district's yellow school buses will be available from express stops at area schools in the afternoon when the program ends at 3 p.m.
- Pick-Up
- School Bus Transportation
Name of Person Picking Student Up at 3 p.m.
Audubon Afternoon Express Route
Prescott Afternoon Express Route
Table Mound Afternoon Express Route

STUDENT INFORMATION