Project Literacy’s Summer Reading Program Application

PLEASE NOTE: This is an application form and NOT confirmed registration. The Summer Reading Program Education Coordinator will contact you directly ONLY IF your child is accepted into the program. If you have not heard from Project Literacy, please assume your child is NOT registered.

The cost for the program is FREE.

Please provide ALL of the following requested information:

Child's Information
Child's Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Gender*
- Male
- Female
- Other
Grade going into September 2025*
Elementary School*
Please provide your child's most recent PM Benchmark Reading Level:*

This must be provided by your child’s teacher.
Which session would you like your child to attend?*
Parent/Guardian Information
Parent/Guardian #1 Name*
First Last
Parent/Guardian #1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian #1 Phone Number*
Parent/Guardian #1 Email Address*
Parent/Guardian #2 Name
First Last
Parent/Guardian #2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email Address
Name of Person Picking Up Child*
First Last
Relationship to Child*
Medical Information
Please list any of your child's allergies or medical conditions, if any.
If required, does your child have an EpiPen?
- Yes
- No
Daytime Emergency Contact Name*
First Last
Daytime Emergency Contact Phone Number*
Is there anything else you would like us to know about your child?
Important Consent Forms
Attendance*
Please read and check.
– Students must be available to attend seven out of eight lessons in the program to be eligible to register.

– To help ensure the health and safety of everyone participating in the program, it is advised that students stay home if they are feeling sick. If they fall ill during the program, the parent/guardian will be contacted to pick up the student.

– We encourage families to drop off students no later than 9:30am and pick them up promptly by 12:30pm.
Child Supplies*
Please read and check.
Please make sure your child brings the following to EACH class:

– Snacks

– Water bottle

– A change of clothing

– Sunscreen and hat

– a backpack (to carry and store books/materials)
Code of Conduct*
Please read and check.
– Out of respect for all the participants in the program, the use of cellphones/electronics is not allowed during class.

– The safety and well-being of each individual is very important to Project Literacy. I hereby agree that any behaviour of the student that places himself/herself or others at risk may result in the student’s immediate dismissal from the program.
Comments
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If you have an issues or questions, please contact Education Coordinator, Pat Pobuda

Project Literacy’s Summer Reading Program Application

Child's Information

Parent/Guardian Information

Medical Information

Important Consent Forms