Please Attach Payment Here
Carpenter Elementary Winter 2017 Intersession Registration Form “Just Build It”
Payment and completed registration form must be turned into the office by January 12.
Please check one of the following methods of payment.
If PaySchools is selected a receipt needs to be attached showing payment.
 Payment Cash/Check/Money Order Attached ($120 per Carpenter Student, payable to Carpenter Elementary).
 Payment via PaySchools ($120 per Carpenter Student). PaySchools receipt must be attached.
Only one registration form needed per family is needed.
Child’s
Name___________________________________Teacher_______________________Grade_____
Medical/Special Needs/Concerns_______________________________________________________
Child’s
Name___________________________________Teacher_______________________Grade_____
Medical/Special Needs/Concerns_______________________________________________________
Child’s
Name___________________________________Teacher_______________________Grade_____
Medical/Special Needs/Concerns_______________________________________________________
Parent’s/Guardian’s Name ___________________________________Phone________________
E-mail_________________@____________Address_________________________ Zip Code_____
Phone numbers in the order you would like us to call if we need to contact you:
Person/Relation_________________________________________Number____________________
Person/Relation_________________________________________Number____________________
END OF DAY DISMISSAL
Circle dismissal for each day and fill in pertinent information below
(changes need to be relayed to office).
Monday
Tuesday
Wednesday
Thursday
Friday
BUS – list number below
BUS – list number below
BUS – list number below
BUS – list number below
BUS – list number below
Pick Up – list name below
Pick Up – list name below
Pick Up – list name below
Pick Up – list name below
Pick Up – list name below
Walker - fill in info below
Walker - fill in info below
Walker - fill in info below
Walker - fill in info below
Walker - fill in info below
Latch Key*
Latch Key*
Latch Key*
Latch Key*
Latch Key*
*Note: Parents are responsible for registering students for the Intersession week with Latchkey staff, extra fees apply.
BUS NUMBER #_____
Parent Pick Up Line – by _____________________________________________________________
(If person is not on above contact list, please include phone number and relation)
Walker - Do they cross Flintridge? Yes____ No_____
There is a $15 processing fee if a cancellation request is made after the teacher meeting. No refunds once the
Intersession program has begun or for school closures.
15, 2017
Yes, I can chaperone or one of my relatives/friends can
Name_____________________________________ Relationship to Student______________________________
Cell Number______________________ Email (if different than student) _______________________________
Circle one: I will be taking the bus /I will be driving and meeting the bus (note- students are not permitted to ride in car)
All chaperones need to complete a background form and turn in to office – if they haven’t yet this year
Thank you, without your help we can’t go on field trips!
Feb. 13 - 17
Winter Intersession 2017
Just Build It
Registration Dec. 14 – Jan. 12
$120 per student
We will be building and creating, using many different mediums.
To help us with our creative process, please start saving your recycles. We can use all of these and any others
you think would be fun useful: Kleenex boxes, empty toilet/paper towel/wrapping paper rolls, bottle caps,
egg cartons, milk/juice and other cartons, thin card board, newspaper, magazines, water/drink bottles,
half/gallon milk jugs, two- liter bottles, shoe boxes & all shaped boxes big and small.
Other items we can use: Styrofoam, packing peanuts, bubble wrap, scrap craft supplies, marbles, small
building supplies, electric/regular wire, used matchbox cars, magnets, peg board, blocks, wood, tiny/small
action figures/characters, small rubber balls, old cd’s, string/twine, mason/baby food jars, corks, twist ties,
empty ribbon or thread spools, pipe cleaners, pool noodles, washers, screws, bolts and any other odds and
ends.
Our field trip will be…
LEGOLAND