2019 Viroqua Area Schools Summer School Program - AWS
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2019 Viroqua Area Schools
Summer School Program
June 10 – July 5
* No School on July 4 *
SUMMER SCHOOL COURSE BOOKLET
REGISTRATION: March 28 – April 17
Sign up for classes based on your child’s current 2018-2019 grade level.
Kate Moll, Elementary Principal and Summer School Coordinator
kmoll@viroquablackhawk.org
608-637-7071
Brenda Haugrud, Elementary Secretary and Summer School Secretary
bhaugrud@viroquablackhawk.org
608-637-7071
Viroqua Area Schools summer school programming includes a morning classroom experience for
resident students with no enrollment fee, and a variety of classroom enrichment classes available
for the afternoon with no enrollment fee. There are specialized classes for middle school and high
school as well as middle school band lessons, and summer orchestra for beginners.
SUMMER SCHOOL BREAKFAST AND LUNCH: Breakfast will be served at 7:30, and lunch will be
served at 11:30 each day in the elementary cafetorium during summer school, June 10 – July 5 (No
School July 4). Breakfast and lunch will be available to all summer school students age 18 and under
who wish to participate - - at no cost to families.
[Note: The Summer Food Program is open to the public daily during summer school from 7:30-8:30
for breakfast and 11:15-12:30 for lunch, and continues after Summer School running until August
9.]
ATTENDANCE: While students are encouraged to attend all summer sessions, we understand that
family trips are often planned during the summer and that some absences are inevitable. Please let
your child’s teacher know ahead of time of any planned absences. If you sign up for one of the
enrichment classes - Bike, Camping, KVR, etc., please note the date so your child is in
attendance. These classes are dependent on enrollment and often have a waiting list. Please
notify the elementary office as soon as you know your child will not be attending to allow
another student to have the opportunity.REGISTRATION: Students are required to enroll in classes according to their current 2018-
2019 grade level. All registration forms are due by April 17. It is important that all students enroll
by April 17 because courses are dropped based on enrollment and the availability of qualified
instructors as of this date. Each student is to have their own registration form and emergency
form. Please do not put two students on one form.
TRANSPORTATION: Transportation to and from summer school is a parent responsibility. Please
utilize the parent pick-up and drop-off area in the NE parking lot. It is important that children are here
on time and picked up promptly at the end of their summer school day.
COURSE OFFERINGS:
CLASSROOM PROGRAM, GRADES PK–K-1-2-3-4
Students are assigned to classrooms with students of their age and peer level. Daily activities include
academics which are enriched by library, music, physical education, and computer instruction.
8:00 – 11:30 Daily from June 10– July 5 (No School July 4)
CLASSROOM MATH AND READING SKILLS AND DRILLS – GRADES 5-6-7-8
Through a variety of activities in and out of the classroom, students will have the opportunity to
strengthen their reading and math skills.
8:00 – 11:30 Daily from June 10– July 5 (No School July 4)
A TO Z – WHAT’S OUR THEME TODAY? – PRE-KINDERGARTEN 2:00-2:50
Working their way through the alphabet, students will learn science - through science activities, math
skills – through counting, adding, & patterning, and language arts – through vocabulary & grammar.
ADVENTURES WITH DISNEY – GRADES 1-2-3 2:00-2:50
Using themes from popular Disney movies like Coco, Frozen, The Incredibles, and more - the
students will practice their reading and math skills through the stories, songs, games, crafts, and
more.
ALLAMAKEE COUNTY CONSERVATION – GRADES 4-5-6-7-8
Monday, July 8 8:00 a.m. – 5:00 p.m.
Students will participate in a skills program from 9:00 a.m. – 3:00 p.m. that will include kayaking,
hiking, and pond skimming. A letter will be sent out prior to the trip to students who register with
additional details.
BASKETBALL INTRODUCTION – GRADES 2-3-4 12:00–12:50
Using individual and group activities, students will learn and develop the skills required to participate
in a game of basketball. Skills that will be focused on are: ball handling, shooting, footwork, offense,
and defense.
BASKETBALL SKILLS DEVELOPMENT – GRADES 4-5-6 12:00-12:50
Students will participate in individual and group activities to use their basketball skills. Students will
use their skills to participate in basketball games.
BEGINNING BAND LESSONS – INCOMING 6TH GRADE BAND STUDENTS
Beginning band lessons for incoming 6th grade students. June 10-July 3 Arrangements will be
made with information provided to students by Mr. Thew.
BEGINNING ORCHESTRA LESSONS – INCOMING 6TH GRADE ORCHESTRA STUDENTS
Beginning orchestra lessons for incoming 6th grade students. August 12-15, August 18-22
Arrangements will be made with information provided to students by Mr. Lebakken.BIKING ON THE SPARTA-ELROY BIKE TRAIL – GRADES 5-6-7-8
Tuesday, July 9 Equipment Check and Practice Ride 9:00-11:00 Mandatory
Wednesday, July 10 Leaving Time: 8:00 a.m. Return Time: 6:00 p.m. (Rain Date July 12)
Students must have a working bicycle. Please check your bike prior to the trip. Helmets are
required! Attendance at the equipment check and practice ride is mandatory to go on the trip.
A letter will be sent out prior to the trip to students who register with additional details.
BOARD GAMES – GRADES 2-3-4-5 1:00 – 1:50
Students will learn new board games and card games and learn the use of strategy.
BOARD SILLY! – GRADES K-1-2 2:00-2:50
Students will learn how to play a variety of games, make some games, and do a variety of activities
so they don’t get “bored silly”!
BOOKS & SNACKS – PRE-KINDERGARTEN 1:00-1:50
Students will learn and experience pre-reading skills, sequencing, storytelling, and literacy skills
through reading fun books and complimentary activities.
CAMPING, ROUND 1, TWO NIGHT – GRADES 5-6-7-8
Fishing, cooking, kayaking, canoeing, hiking, and cooking meals over an open fire at Sidie Hollow.
Students wanting to fish need to bring their own poles and bait. A letter will be sent out prior to the trip
to students who register with additional details.
Leave Time: 9:00 a.m. Tuesday, July 23 Return Time: 4:00 p.m., Thursday, July 25
CAMPING, ROUND 2, TWO NIGHTS – GRADES 5-6-7-8
Fishing, cooking, kayaking, canoeing, hiking, and cooking meals over an open fire at Sidie Hollow.
Students wanting to fish need to bring their own poles and bait. A letter will be sent out prior to the
trip to students who register with additional details
Leave Time: 9:00 a.m. Tuesday, August 13 Return Time: 4:00 p.m., Thursday, August 15
.
CANOEING THE TITANIC IN ONTARIO– GRADES 5-6-7-8
Students will participate in a day of outdoor activities including hiking, canoeing, and other nature
experiences. A letter will be sent out prior to the trip with additional details for all registered students.
Thursday, July 11 Leave Time: 8:00 a.m. Return Time: 3:00 p.m. (Raindate July 12)
CAVE OF THE MOUNDS – GRADES 4-5-6-7-8
Students will participate in an outdoor hike and a cave tour. Each student will get a bag of sand to
use the sluice to uncover and then identify their own collection of rocks to keep.
Friday, July 26 Leave Time: 8:00 a.m. Return Time: 4:00 p.m.
CRAFTING WITH NATURE – GRADES 5-6-7-8 1:00-1:50
Students will participate in outdoor activities and take things from nature and make fun crafts.
CRIBBAGE FOR BEGINNERS – GRADES 4,5,6 2:00-2:50
Students will learn to play the ever popular game of cribbage from start to finish. Students will learn
the history, rules, and strategies of the game.
DRAMA – GRADES K-1-2 12:00-12:50
Students will learn character development, improvisation, movement, and memorizations. Student
will learn short scripted scenes. Improvisation based on characters, situations, and first lines.
DRAMA – GRADES 3-4-5 1:00-1:50
Students will learn character development, improvisation, movement, and memorizations. Student
will learn short scripted scenes. Improvisation based on characters, situations, and first lines.DRAMA – GRADES 6-7-8 2:00-2:50 Students will learn character development, improvisation, movement, and memorizations. Student will learn short scripted scenes. Improvisation based on characters, situations, and first lines. FINDING THE LOST TRIBE OF TOCOWANS – GRADES 1-2 12:00-12:50 Students will be working on addition, subtraction, estimating, planning, decision-making, and working as a group in an interactive simulation searching for a group of the Lost Tribe of Tocowans. FISHING CLASS - TWO WEEKS – GRADES 3 AND UP This two week fishing class is for any child in 3rd grade and up who would like to learn more about fishing and enjoy the outdoors. Fishing trips will focus on the man-made lakes near Viroqua. We will be promoting catch and release fishing. A note with further details will be sent home prior to the class. June 10 – 21 12:00-3:00 FOOTBALL SKILLS – GRADES 4-5-6-7-8 1:00-1:50 Students will learn basic football skills: passing, catching, kicking, punting, and more. Students will also learn to play the game of flag football. FUN WITH FABRIC – GRADES 5-6-7-8 12:00-12:50 Students will use fabric scraps and use them to create various projects. Students will enjoy making various craft projects using fabric as the main material for the crafts. FUN WITH PIGGIE AND ELEPHANT – GRADES K-1-2 12:00-12:50 Students will read Piggie and Elephant books by Mo Willems. Students will enjoy Reader’s theatres, crafts and games – all from the books! FUN WITH WATER! – GRADES K-1-2 2:00-2:50 Students will enjoy playing games with water, learning about water animals, and reading stories about weather and water. GYM GAMES – GRADES K-1-2 1:00-1:50 Students will keep active by playing their favorite Physical education games and possibly learn some new ones! Students will have fun, get some exercise, and learn about teamwork, fair play, and sportsmanship. GYM GAMES – GRADES 3-4-5 2:00-2:50 Students will keep active by playing their favorite Physical education games and possibly learn some new ones! Students will have fun, get some exercise, and learn about teamwork, fair play, and sportsmanship. HEALTHY SNACKS – GRADES 5-6-7-8 NOTE: 2 HOUR CLASS 1:00-2:50 Students will learn math fractions and ratios by using recipes. Students will learn social skills and life skills making healthy snacks from scratch. KVR – KICKAPOO VALLEY RESERVE TRIP – CANOE AND POND SKILLS - GRADES 4-5-6-7-8 Students will spend time at the Kickapoo Valley Reserve learning canoe skills, pond study, and play rondevous games. A letter will be sent out prior to the trip to students who register with additional details. Wednesday, July 17 Leave Time: 8:00 a.m. Return Time: 3:00 p.m. KVR – KICKAPOO VALLEY RESERVE TRIP – CHALLENGE COURSE– GRADES 4-5-6-7-8 Students will spend time at the Kickapoo Valley Reserve participating in the Challenge Course, Orienteering, and a Survival Skills class. A letter will be sent out prior to the trip to students who register with additional details. Friday, July 19 Leave Time: 8:00 a.m. Return Time: 3:00 p.m.
LET’S PLAY! – PRE-KINDERGARTEN 12:00-12:50
Students will participate in free play, outdoor play, and game activities to use their social-emotional
skills (sharing materials, taking turns), their language skills, and their readiness skills.
MADISON ZOO FIELD TRIP – GRADES 5-6-7-8
Students will explore the Madison zoo to learn about plants and animals.
Tuesday, July 16 Leave Time: 8:00 a.m. Return Time: 5:00 p.m. (Raindate July 18)
MAGICIAN SCHOOL – GRADES K-1-2 2:00-2:50
Students will learn card tricks, optical illusions, and other magic tricks! Students will listen to stories
about magicians and magical stories.
MAGICIAN SCHOOL – GRADES 2-3-4-5 1:00-1:50
Students will learn card tricks, optical illusions, and other magic tricks! Students will listen to stories
about magicians and magical stories.
MATH GAMES – GRADES 3-4-5-6 12:00–12:50
Students will learn and play math games in pairs, groups, individually and as a whole class. Students
will work on math facts using creative ways to make math fun!
RANDOM ACTS OF KINDNESS – GRADES K-1-2 1:00–1:50
This class is dedicated to promoting kindness and compassion in our schools, homes, and
communities. During this class students will work to spread kindness throughout the community by
making projects, delivering snacks, creating pictures, and so much more!
READ IT AND EAT IT! – GRADE K-1-2-3 1:00 – 1:50
Students will listen to stories and make/taste new foods to go along with the stories. Students will
write about the stories and make their writing into a book.
RECESS!! – GRADES K-1-2-3-4 2:00-2:50
Students will learn and participate in outdoor recess games. They will learn team sports, being
respectful, and good playground behavior.
ROLLER SKATING – GRADES 3-4-5-6-7-8
Students will learn how to roller skate and learn the importance of exercise. Students will receive a
lesson about exercise and then have time to roller skate at High Rollers in LaCrosse. A letter will be
sent out prior to the trip to students who register with additional details.
Tuesday, July 9 Leave Time: 11:30 Return Time: 4:30
SCRAPBOOKING! GRADES 3-4-5-6-7-8 12:00 – 12:50
Students will learn how to make their own scrapbooks, learning how to cut and organize pages and
pictures. Students will learn journaling about their photos, and many other skills working with photos.
Students will need to bring their own pictures to work with.
SPACE EXPLORATION – GRADES 2-3-4 12:00-12:50
Students will learn about the nighttime sky, constellations, planets, moons, and galaxies.
SPANISH! – GRADES 2-3-4 1:00-1:50
This class is an introduction to Spanish! Students will learn new phrases, colors, numbers, and learn
about the Hispanic culture.
STEAM 1 – SCIENCE, TECHNOLOGY, ENGINEERING, ART & MATH – GRADES 3-4 12:00-12:50
Students will work with Science, Technology, Engineering, Art and Math to build confidence and
understanding. Students will come away from the class with many exciting projects and activities.STEAM 2– SCIENCE, TECHNOLOGY, ENGINEERING, ART & MATH – GRADES 5-6 1:00-1:50 Students will work with Science, Technology, Engineering, Art and Math to build confidence and understanding. Students will come away from the class with many exciting projects and activities. STEAM 3– SCIENCE, TECHNOLOGY, ENGINEERING, ART & MATH – GRADES 7-8 2:00-2:50 Students will work with Science, Technology, Engineering, Art and Math to build confidence and understanding. Students will come away from the class with many exciting projects and activities. TRAMPOLINE FUN! – GRADES 3-4-5-6-7-8 Students will learn the importance of exercise and how to make exercise fun. Students will receive a summer activity calendar/tracker. The lesson will be followed up by exercise at the Jumpstart Trampoline Park in LaCrosse. A letter will be sent out prior to the trip to students who register with additional details. Monday, July 15, Leave Time: 11:30 a.m. Return Time: 4:30 p.m. TRAVELING ACROSS THE USA- GRADES 4-5-6 12:00-12:50 Students will travel across the USA by “visiting” national parks and places of interest in each region. Students will use technology to explore places of interest. TURN BACK TIME, TODAY IN HISTORY – GRADES 4-5-6 1:00-1:50 Students will explore famous events that happened today in history. Students will also look at what happened in the day of their birthday and they year they were born. ZOO FRIEND FUN – CRAFTS, STORIES, & MOVEMENT – GRADES K-1-2 12:00-12:50 Using the Zoofriend Alphabet, students will make crafts of the letter of the animals, review letters and sounds, read stories, play learning games and do movement activities. TUITION FOR NON-RESIDENT STUDENTS: Any student seeking entrance into the Viroqua Area Schools Summer School Program must reside within the established boundaries of the district/or participate in Open Enrollment. The child’s parent or legal guardian must reside within the Viroqua School District boundaries. Non-resident students will be charged tuition in accordance with state tuition laws (121.77). Non-resident students who have applied to the Board of Education by April 30, 2019 for the Public School Open Enrollment Program, and have been approved to enroll for the 2019-20 school year, may be waived for tuition for summer school enrollment. Summer school tuition is: $606 for the Morning Session, and $144 for each of the afternoon enrichment classes. Tuition can be calculated if requested for the non-enrichment classes (fishing, camping, biking, etc.) IMPORTANT REGISTRATION INFORMATION: The next four pages are for registration purposes. There are several classes offered that will have a limited enrollment cap. Registration for all classes is first come, first serve. Please make sure to complete all four pages of the registration – even if the page does not include a class your child is taking. All pages must be filled out completely. The third page has a parent signature portion that must be signed and dated. Failure to return all four pages will result in a delay in your child’s registration, with the student potentially missing out on a class that has limited enrollment.
VIROQUA AREA SCHOOLS SUMMER SCHOOL REGISTRATION FORM
Sign up for classes based on your child’s current 2018-2019 grade level.
THIS SECTION MUST BE COMPLETED FOR REGISTRATION, PLUS SIGNATURE PAGE 3.
Student Name: _____________________________________________________________________________
Parent/Guardian: ______________________________________ Home Phone #: _________________
Address: _____________________________________________ City/State: ____________________
Current 2018-19 Grade Level ______ Elementary Only: Current 2018-19 Classroom Teacher_____________
Do you live in the Viroqua School District: __YES __NO If no, which district? ________________________
There is only one session of classes, lasting 19 days. Classes run from June 10 – July 5 with no school on July 4.
MORNING 8:00 – 11:30
___ Classroom Program (Grades PK-K-1-2-3-4)
___ Classroom Math & Reading Skills & Drills (Grades 5-6-7-8)
ENRICHMENT CLASSES GROUP 1, 12:00–12:50 (grade level in parenthesis)
___Basketball Introduction (2-3-4)
___Basketball Skills Development (4-5-6)
___Drama (K-1-2)
___Finding the Lost Tribe of Tocowans (1-2)
___Fun With Fabric (5-6-7-8)
___Fun with Piggie & Elephant (K-1-2)
___Let’s Play! (PK)
___Math Games (3-4-5-6)
___Scrapbooking (3-4-5-6-7-8)
___Space Exploration (2-3-4)
___STEAM 1 (3-4)
___Traveling Across the USA (4-5-6)
___Zoo Friend Fun (K-1-2)
ENRICHMENT CLASSES GROUP 2, 1:00 – 1:50 (grade level in parenthesis)
___Books and Snacks (PK)
___Board Games (2-3-4-5)
___Crafting With Nature (5-6-7-8)
___Drama (3-4-5)
___Football Skills (4-5-6-7-8)
___Gym Games (K-1-2)
___Healthy Snacks (5-6-7-8) NOTE: THIS IS A TWO HOUR CLASS 1:00-2:50
___Magician School (2-3-4-5)
___Random Acts of Kindness (K-1-2)
___Read it and Eat It! (K-1-2-3)
___Spanish (2-3-4)
___STEAM 2 (5-6)
___Turn Back Time, Today in History (4-5-6)
ENRICHMENT CLASSES GROUP 3, 2:00–2:50 (grade level in parenthesis)
___A to Z, What’s Our Theme Today? (PK)
___Adventures With Disney (1-2-3)
___Board Silly! (K-1-2)
___Cribbage for Beginners (4-5-6)
___Drama (6-7-8)
___Fun With Water (K-1-2)
___Gym Games (3-4-5)
___Magician School (K-1-2)
___Recess!! (K-1-2-3-4)
___STEAM 3 (7-8)
___BACK TO SCHOOL REFRESHER (K-1-2-3) JULY 29-AUGUST 9 (See page 3 for description)
DUE APRIL 17, 2019 Page 1 of 4, RegistrationVIROQUA AREA SCHOOLS SUMMER SCHOOL REGISTRATION FORM
Sign up for classes based on your child’s current 2018-2019 grade level.
THIS SECTION MUST BE COMPLETED FOR REGISTRATION, PLUS SIGNATURE PAGE 3.
Student Name: _____________________________________________________________________________
Parent/Guardian: ______________________________________ Home Phone #: _________________
Address: _____________________________________________ City/State: ____________________
Current 2018-19 Grade Level ______ Elementary Only: Current 2018-19 Classroom Teacher_____________
Do you live in the Viroqua School District: __YES __NO If no, which district? ________________________
ENRICHMENT CLASSES ON OTHER DATES DURING SUMMER SCHOOL:
This page contains enrollment information for the additional class offerings outside of the four week Summer
School session. If you sign up for the one or two day enrichment classes (Bike, Camping, KVR, etc.), please note
the date so your child is in attendance. These classes are dependent on enrollment and often have a waiting list.
Please notify the elementary office as soon as you know your child will not be attending to allow another student
to have the opportunity.
_____ ALLAMAKEE COUNTY CONSERVATION – GRADES 4-5-6-7-8
Monday, July 8 Leaving Time: 8:00 a.m. Return Time: 5:00 p.m.
_____ BIKING ON THE SPARTA-ELROY BIKE TRAIL – GRADES 5-6-7-8
Tuesday, July 9 Equipment Check and Practice Ride 9:00-11:00 MANDATORY
Wednesday, July 10 Leaving Time: 8:00 a.m. Return Time: 6:00 p.m.
(Rain Date July 12)
_____ CAMPING, ROUND 1, TWO NIGHT – GRADES 5-6-7-8
Leave Time: 9:00 a.m. Tuesday, July 23 Return Time: 4:00 p.m., Thursday, July 25
_____ CAMPING, ROUND 2, TWO NIGHTS – GRADES 5-6-7-8
Leave Time: 9:00 a.m. Tuesday, August 13 Return Time: 4:00 p.m., Thursday, August 15
_____ CANOEING THE TITANIC IN ONTARIO– GRADES 5-6-7-8
Thursday, July 11 Leave Time: 8:00 a.m. Return Time: 3:00 p.m. (Raindate July 12)
_____ CAVE OF THE MOUNDS – GRADES 4-5-6-7-8
Friday, July 26 Leave Time: 8:00 a.m. Return Time: 4:00 p.m.
_____ FISHING CLASS - TWO WEEKS – GRADES 3 AND UP
June 10 – 21 12:00-3:00
_____ KVR – KICKAPOO VALLEY RESERVE TRIP – CANOE AND POND SKILLS - GRADES 4-5-6-7-8
Wednesday, July 17 Leave Time: 8:00 a.m. Return Time: 3:00 p.m.
_____ KVR – KICKAPOO VALLEY RESERVE TRIP – CHALLENGE COURSE–GRADES 4-5-6-7-8
Friday, July 19 Leave Time: 8:00 a.m. Return Time: 3:00 p.m.
_____ MADISON ZOO FIELD TRIP – GRADES 5-6-7-8
Tuesday, July 16 Leave Time: 8:00 a.m. Return Time: 5:00 p.m. (Raindate July 18)
_____ ROLLER SKATING – GRADES 3-4-5-6-7-8
Tuesday, July 9 Leave Time: 11:30 Return Time: 4:30
_____ TRAMPOLINE FUN! – GRADES 3-4-5-6-7-8
Monday, July 15 Leave Time: 11:30 a.m. Return Time: 4:30 p.m.
DUE APRIL 17, 2019 Page 2 of 4, RegistrationStudent Name: _____________________________________ Grade: ______________
PARK AND REC SHUTTLE BUS
A morning shuttle service will be provided during summer school for students who attend summer
school (June 10-July 5) and are also involved in the City Park & Recreation programs. The shuttle
will run from 8:00-11:30, Monday – Thursday only. Please indicate if you will be using this shuttle
service - this information must be provided for each child using the service.
Will you use the Park & Recreation Shuttle Bus? __YES __NO If yes, please list activities, dates,
and times that the shuttle will be used?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
ADDITIONAL TWO WEEK
BACK TO SCHOOL REFRESHER CLASS
JULY 29-AUGUST 9 GRADES K-1-2-3
BACK TO SCHOOL REFRESHER CLASS – GRADES K-1-2-3
A two week morning class is available for students to brush up on their reading and math
skills and get ready to come back to school. The breakfast and lunch program will
continue to be available during the class.
Monday through Friday July 29 – August 9
7:45 Breakfast
8:00-11:30 Classroom
11:30-12:00 Lunch All students need to be picked up no later than 12:00.
PLEASE INDICATE PARTICIPATION ON PAGE 1 OF THE REGISTRATION FORM.
PARENT NOTE & SIGNATURE FOR ALL REGISTRATION:
There are several classes offered that will have a limited enrollment cap. Registration for all classes is
first come, first serve. Please make sure to complete all four pages of the registration – even if the
page does not include a class your child is taking. Failure to return all four pages will result in a delay
in your child’s registration, with the student potentially missing out on a class that has limited
enrollment. If plans change for your family, please notify the elementary office as soon as you know
your child will not be attending to allow another student to have the opportunity.
__________________________________________________ ________________________
Parent Signature (REQUIRED) Date
DUE APRIL 17, 2019 Page 3 of 4, RegistrationVIROQUA AREA SCHOOLS SUMMER PROGRAM
EMERGENCY INFORMATION
Child’s Name _____________________________________________________________
Date of Birth ____________________
Parent/Guardian Name _____________________________________________________
1st Contact Phone Number _______________________________
2nd Contact Phone Number _______________________________
3rd Contact Phone Number _______________________________
Two local people to contact of parent/guardian cannot be reached. Please list two
separate households:
1. _________________________________Relationship_____________Phone________
2. _________________________________Relationship_____________Phone________
Please list any health conditions about which summer school staff should be aware
(i.e. asthma).
Please note that school staff does not administer medications (other than those
for a chronic health condition) during the summer program.
If a parent/guardian/emergency contact listed above is not able to be contacted,
this document authorizes Viroqua Area School District to use their judgment to
provide medical care/treatment as needed.
Physician/Clinic___________________________________________Phone___________
Signature of Parent/Guardian________________________________________________
Date ________________
** THIS FORM MUST BE RETURNED WITH REGISTRATION MATERIALS **
ONE CHILD LISTED PER FORM, PLEASE
DUE APRIL 17, 2019 Page 4 of 4, RegistrationYou can also read
