2017 CT COLT Rhyme Celebration (Pre K- 6th)
Registration Form
Wednesday, April 5, 2017
5:00-7:00 P.M. (Snack will not be provided)
Venue: Smith Middle School, 216 Addison Rd., Glastonbury, CT
Chair: Kate Krotzer
Host: Glastonbury Public Schools
2017 Theme: "Me and My Global Community”
Rhymes, Songs and Tongue Twisters
PRINT CLEARLY:
Name of Student:_________________________________________Grade in school:________________
Language:____________________________ Heritage: Yes / No Home email:____________________
Name of School:_______________________________________________________________________
Address of School:_____________________________________________________________________
I accept that my child will participate in the CT COLT RHYME CELEBRATION to be held on the
above date at the above location and I permit transportation for my child to and from the event. I also
understand and accept that my child will be photographed or filmed (DVD) for CT COLT and ACTFL and
that some of the takes may be displayed on the Internet for educational purposes only.
_____________________________________________
Signature of Parent or Guardian
If you DO NOT want your child photographed or videotaped, you must state this in writing, with signature and date. Please be
aware that this means your child’s entire group cannot be photographed or videotaped and an announcement will be made to the
general public. Attach this written request to the signed registration form.
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For Teacher only: Please email your students’ names and rhymes on a page set up in the same format
as the program booklet (see sample page) to [email protected]. Please use Times Roman and
font 12. This email MUST arrive by January 25th.
I accept responsibility for students during the CT COLT RHYME CELEBRATION and will release
students to designated parents/guardians.
__________________________________________________________
Signature of Language Teacher
Name of Teacher:______________________________________________
Home phone:_______________________Cell:_______________________
E-mail:_______________________________________________________
Name of school: __________________________________________________________________
School address: ___________________________________________________________________
School principal: __________________________________________________________________
Current CT COLT member: ______ yes ________no
**If you are not a COLT member, there is an additional $30 fee to participate, which also covers a one –year
membership to COLT. Please go to www.ctcolt.org to complete the COLT membership form.
Please send by Post Office the check to CT COLT and the signed registration forms by Feb. 1st
Send $5.00 per child, $10.00 per school, and $30.00 one year membership fee (if needed) in a check made out to
CT COLT. No Purchase Orders accepted.
Kate Krotzer
16 Hubbard Drive
Glastonbury, CT 06033
Tel: 860-918-1048
E-mail [email protected]