to the best of my knowledge, my child reads: above level ... · neighbor/friend school flyer...
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TRINITY LUTHERAN CHURCH
508 Center Street, Ashland, Ohio 44805-3341
Summer Reading Program Registration— Please complete one form per child
Parent Name(s) Students Name Age
Home Phone Work/ Cell Phone Grade completed/ School Date of Birth
Address City State Zip
Student brought in a.m. to the program by:
Will be picked up daily at close of program by:
EMERGENCY CONTACT OTHER THAN PARENT:
Any conditions of which we should be aware? (Allergies, Diabetes, Physical Impairments, etc.):
Does student attend Church regularly? ______ Yes ______ No
Name of Church
How did you learn about our Summer Reading (circle all that apply):
Neighbor/friend School flyer Ashland Times Gazette
Mansfield News Journal Website Newsletter Bulletin Other
To the best of my knowledge, my child reads:
_____ above level _____ at level _____ below level
Come join us for our Summer Reading Program for children in kindergarten through 4th grade!
July 11-22 at 8:45 AM-12:00 PM
Contact Dawn Forbes…
Phone: 419-289-2126
Fax: 419-289.1381
Email: [email protected]
MISSION INFORMATION
A Christian-based program Fun-filled with hands-on projects
Staffed by certified teachers
Just fill out the registration form and return with fee by Friday, June 10.
$25 if registered by June 6 OR... Cost: $30 per child
Each additional child is $20
Scholarships available
Class
sizes
are
lim
ited s
o HURRY!