Application for Summer Elementary Program Please provide the following information about your child for Oakhurst's Summer Elementary Program. This program is for elementary age children up to age 12 and provides care during the summer break. Child's name * Child's age and grade * Gender * Yes No Main e-mail for parents/guardians Parent or guardian #1's name * Phone number * Relationship to child * Parent or guardian #2's name Phone number Relationship to child Does the child live at more than one address weekly? (Example: Shared Custody) * Yes No What kind of care will you need this summer? * Full time (5 days a week) Part time (2-3 days a week) Part time (every other week) Partial full time (only custody weeks) Please further explain care needed (if applicable). Does your family qualify for assistance with tuition through Connect or Link Resource and Referral? Yes No If unsure, please contact Connect (Kanawha County) at 304.414.4488 or Link (Putnam County) at 304.523.9540. Tell us about your child's personality. * Does your child have any special needs? Understanding these needs will help us better care for your child. Does your child have siblings who attend Oakhurst presently or in the past? * Yes No If yes, please list their names:
