DMS Summer Learning Academy Registration

Please complete all of the information below in order to properly register your child for DMS SLA.

Name


  1. Please provide your child's first and last name.


  1. In which grade is your child currently enrolled?
    5
    6
    7
    8


  1. Please provide the following information:
    Parent/Guardian's Name
    Address (including zip code)
    Home Phone Number


  1. Please check which program(s) your child will attend:
    Reading AND Math
    Reading ONLY
    Math ONLY


  1. Please provide your child's current bus # and current bus stop.


  1. After looking at the yellow "Dorseyville Middle School Summer Bus Runs", please state which Bus # and Bus Stop your child will be using this summer. (Please state NONE if you plan on providing transportation.)


  1. Please provide the name, relation to child, phone number, and alternate phone number for the 1st Emergency Contact Person.


  1. Please provide the name, relation to child, phone number, and alternate phone number for the 2nd Emergency Contact Person.


  1. Please provide any additional medical/educational information we need to be aware of (allergies, medications, etc).