DISTRICT 7 – SUMMER CAMP PROGRAM PARENTAL CONSENT ENROLLMENT APPLICATION
COMMISSIONER HENRI E. BROOKS DISTRICT 7 – SUMMER CAMP PROGRAM PARENTAL CONSENT ENROLLMENT APPLICATION
Student Name - Last Name
Student Name - First Name
Student Name - Middle Name
Address
Zip Code
Shelby County Commission District
Father Name
Mother’s Name
Father - Telephone (Work) Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mother - Telephone (Work) Number
Please enter a valid phone number.
Format: (000) 000-0000.
Father - Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Mother - Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Father - Email
example@example.com
Mother - Email
example@example.com
What grade will the participant be enrolling next year?
Participant’s Reading Scores from this year
Participant’s Math Scores from this year
Participant’s test scores
Participant must write a simple paragraph on another sheet of paper explaining why he/she would like to attend the summer camp.
Does the participant have any special health issues?
If so, what special health issues?
Are the participant allergies to anything?
If so, what allergies?
Emergency Contact Name
Emergency Contact Telephone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: