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TRINITY LUTHERAN CHURCH 508 Center Street, Ashland, Ohio 44805-3341 Summer Reading Program Registraon— Please complete one form per child Parent Name(s) Students Name Age Home Phone Work/ Cell Phone Grade completed/ School Date of Birth Address City State Zip Student brought in a.m. to the program by: Will be picked up daily at close of program by: EMERGENCY CONTACT OTHER THAN PARENT: Any condions of which we should be aware? (Allergies, Diabetes, Physical Impairments, etc.): Does student aend Church regularly? ______ Yes ______ No Name of Church How did you learn about our Summer Reading (circle all that apply): Neighbor/friend School flyer Ashland Times Gazee Mansfield News Journal Website Newsleer Bullen Other To the best of my knowledge, my child reads: _____ above level _____ at level _____ below level
