Information from Parents

The following information was requested from parents:

2009 “Summer Learning Adventure” Information Sheet
(Return this form to your student’s school office no later than May 15, 2009)

Student’s Name __________________________________________Gender  M  F
(Please Print)
Parent’s Name(s) _________________________________________

Address _______________________________________________

Home Phone ______Cell Phone(s) _________Work Phone(s) ___________

School in Madison School District that student NOW attends:

Adams Archer Burton Hibbard Kennedy Lincoln Lyman Middle School
 Jr. High

PRESENT Grade Level (2008-2009 School Year) ____________

**********************************************

 My child will be walking or riding a bike to summer school.

 I, the parent/guardian, will transport my child to and from summer school.

 Another designated party will transport my child to and from summer school.

Designated person, daycare or bus service & phone #:

___________________________________________

 My child will walk, ride a bike or be transported to and from his/her local school and then ride the school bus from the local school to Burton Elementary OR Madison Middle School and be bused back to their local school.

 I have discussed proper behavior with my child and understand what happens on the third offense of behavior that impedes the educational process.


If there are custody issues or other concerns that you have in regard to your child’s safety that the school needs
to be aware of before summer school begins, please contact Mr. Busby at 359-3332 or Mr. Shirley at 359-3333.

 I understand that during Summer Learning Adventure, my child may participate in a fun activity
that may transport them from the campus such as a movie, roller skating or a field trip of some sort.


Parent Signature _____________________Date _____________________