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Wrentham Summer Institute 2017
WRENTHAM SUMMER INSTITUTE:
Our program runs from 9 am to 12 noon,
Monday through Friday (except the week of
July 4th). At the end of each day the
instructor will accompany your child outside
the school and wait with them until a parent
or guardian arrives for a prompt pick up.
SESSION DATES:
Session One: June 26-30
Session Two: July 3,5-7
Session Three: July 10-14
Session Four: July 17-21
SESSION FEE:
Received by May 31: $100
As of June 1: $105
As of July 1: $110
EXTENDED HOURS:
We are pleased to offer extended hours for
Summer Institute participants for all 4
sessions.
Monday-Friday 12:00-4:00
$125/session
GRADE LEVELS:
Please make note of the grade level
indicated for each course. It reflects the
grade your child will be entering in
September 2017.
LOCATION:
The Summer Institute will be based at the
Roderick School. Drop off and pick up will
be at the Randall Road entrance. Outdoor
classes will be assigned an indoor location
to meet in case of rain. Look for our
banners and our friendly staff members to
guide you on your first day of class.
HOW TO REGISTER:
Complete a separate registration form and
medical form for each child that you are
enrolling. Include a second choice for each
session your child is registering for.
You do not have to be a Wrentham resident
to register. If you are not a Wrentham
resident, please send the 2 registration
forms PLUS a copy of your child’s physical
form including immunizations.
Full payment MUST accompany your
registration.
Please send to:
Roderick Elementary School
ATTN: WSI- Lori DeTrolio
120 Taunton Street
Wrentham, MA 02093
Confirmations will be sent in June.
Refund requests will only be honored prior
to JUNE 1st minus a $10 processing fee.
NO REFUNDS will be honored after June
1st. Refund processing may take
approximately 4-6 weeks.
Please make checks payable to:
Wrentham Public Schools
Questions:
Please contact Lori DeTrolio
508-384-5430
Wrentham Summer Institute Course Description
Session 1- June 26th-June 30th
Motor Movement
Grade level- PreK-2nd
Get those fingers and legs ready to work! During this class we will be working on activities
that benefit fine and gross motor skills. For our fine motor skills we will be using playdough,
sand, shaving cream and other materials to strengthen fine motor skills in many fun ways!
Obstacle courses and other games will help us with our gross motor skills.
Instructor- Ms. Walsh
“Oh the Places We Will Go” Kindergarten Kickoff
Grade level- K
Calling all children entering kindergarten! Come and meet some of your future classmates!
Learn your way around the classroom and school. Parents, your child will have exposure to
the kindergarten word wall words and experience some new math activities. These lessons
will be aligned with the state common core standards. Give your child a JUMP START and
help them KICK OFF a fabulous year in kindergarten.
Please join, Mrs. Stephanie Buckley, Mrs. Sue Traversi and Mrs. Faith Williams as we
introduce your child to kindergarten here at the Delaney School. From arrival at the bus circle
and until dismissal from the same spot, we will follow a typical kindergarten schedule and
routine. Children will rotate from their classroom learning environment to other special
subjects including, art, music, technology, and of course physical education! This class will
take place in the Vogel School. Children will have an opportunity to visit the art and music
classrooms where they will have class in the fall. Activities will be planned in both locations.
Your child will also have class in the computer lab located in the Vogel, and will have an
opportunity to use some of the programs they will be using throughout the school year.
Finally, we will introduce your child to the awesome Delaney Playground!
We cannot wait to meet our future kindergarten students please consider joining us
Instructors: Mrs. Traversi & Mrs. Buckley
On Holiday
Grade level- K-4th
Do you love to celebrate the holidays? If you do, then come join the fun! Each day a different
holiday will be celebrated. Will you be my Valentine on Monday? How about catching a
Leprechaun on Tuesday. Let’s have a cook-out for the Fourth of July. Trick or treat and wear
a costume for Halloween. End the week with the most wonderful time of year, Christmas.
We will be busy decorating for each holiday, creating fun crafts, making and eating yummy
snacks, and playing holiday themed games. This week will be packed with
fun filled holiday activities.
Instructor- Mrs. Blake
Animal Antics
Grade level-K -6th
Come visit, and play with animals while we learn about them! We will have real animal
visitors like dogs, rabbits, guinea pigs, turtles, and birds. Each day we will have live animals as
our role models and friends while we learn interesting facts about the animal, do crafts, and
play games outside based on the animal of the day. We may do some food crafts too if the
animals don’t get too hungry!!
Instructor- Mrs. Foxx
Tie Dye
Grade level- K-6th
Welcome back to the very popular tie dying bonanza with Miss Brackett! If you love the look
of bright tie dyed shirts, head bands, sweatshirts, or even bandanas then this is the class for
you! Enjoy the sunny summer days while creating your own masterpieces of tie-dye clothing
and accessories. You can even bring in your own things from home to tie-dye! Some kids
even brought sheets and curtains! Do not miss out on this once a year celebration!! * Please
wear clothes you do not care about getting tie dyed.
Instructor- Miss Brackett
Jump Start to First Grade
Grade level- 1st
Would you like to learn what first grade is all about? Come spend a week getting ready for all
the fun in first grade! During our week together, you will get a sneak peek of what you will
learn in first grade, as well as a refresher (or introduction) to the fabulous places in our school!
Have fun making crafts, playing games, and learning new things!
Instructor- Miss Blake
Letterboxing and Water Fun Play
Grade level- 2nd -5th
What could be more fun than finding a hidden treasure? Finding a treasure and running
through the sprinkler, that’s what! Have fun, stay cool! Letterboxing is an intriguing mix of
hiking, puzzle solving, treasure hunting and rubber stamping. Throughout the week we will
spend time indoors and out. Each child will choose a code name, decorate a letterboxing bag
and create a few rubber stamps. They will be able to take all of their supplies home at the end
of the week. We will hike the school grounds and Sweatt Hill areas in search of hidden
treasures and end each day by cooling off with lots of water play fun!! So bring a towel,
sunscreen, bug spray, a water bottle and a snack and get ready for lots of fun!
Instructor- Mrs. Lynch
Games Galore!
Grade level- 2nd-5th
Do you love to play games? Come and hang out with your friends, play some of your old
favorites and learn some new ones too. Board games, card games, brain games, movement
games, challenge games (e.g. Minute to Win it), the sky is the limit. We will try them all! Do
you have a favorite game? You can bring that too.
Instructor- Mrs. Amy Farrell
Summer Reading Jump Start
Grade level 2nd- 6th
Do you LOVE to read? If so, this class is perfect for you!
With the library at your fingertips, begin your summer with a great book. Sign up for summer
reading at the Fiske Library and begin the journey to reach summer reading goals. Join with
friends and spend your mornings reading short stories, poems, plays or chapter books. We will
spend time in the shade outside and in the Roderick Library- sharing great stories and reading
together. At the end of the week, we will submit our minutes to the Fiske Library and receive
credit for our reading minutes.
Instructor: Mrs. Lopez
Art Projects
Grade level- 3rd-5th
Do you love art? Do you want to design your own projects? Join our class and design and paint
your own stuffed animal. In addition you will draw, sculpt, craft and play games.
Instructor: Mrs. Lovely
Pottermania
Grade level- 3rd-6th
Harry Potter fans, enter the world of Hogwarts and Harry Potter! Immerse yourself in the
adventures of Harry Potter and his friends. Join us as we read “The Cursed Child,” have Harry
Pottery experiences, such as getting sorted into Hogwarts houses, learn spells and learn to play
Quidditch. We will finish up with a trip to “Hogsmead” and some Butter Beer.
Instructor: Ms. DeTrolio
Scratch #111
Grade level 4th – 6th
In this program, the student spends the week learning how to create animations and games with
the Scratch software. In addition to class instruction and free time to explore Scratch, the
students will participate in breaks from the computer screen and learn about various computer
science topics. The students will create either a game or animation that they may present on
Friday.
Instructor: Miss Lopez
Kid Around and Be Kind Yoga
Grade level 2nd- 6th
Lots of energy, lots of laughing, lots of fun! The special music in this yoga class will get you
moving, grooving, shaking, stretching, running, jumping, skipping, hopping and doing all things
yoga! Focusing on what you’re thankful for each morning, creating mindful crafts, and spreading
kindness in the community are all a part of this feel good class! You will deeply relax as you
journey into your very own ‘secret garden,’ and learn how to use your breath anywhere, anytime
to help you calm down and focus. No yoga experience necessary, start where you are, everyone
is welcome! See you this summer in Kid Around and Be Kind Yoga.
Instructor: Ms. Boocock
Session 2-July 3,5, 6, 7
Cupcake Heaven
Grade level- K to 6th
Do you love cupcakes? Do you love making them at home or with friends? If you said Yes
then this class is for you! At Cupcake Heaven we will be baking cupcakes and decorating with
frosting for an entire week!! Do you love chocolate? Maybe Vanilla? BOTH?! Take this
class and we will bake all flavors and even make your own pink or blue sparkly frosting!!
Have a gluten allergy? We can use gluten free baking mix so you can join in on the fun too!
Please note the kitchen is not a gluten free or peanut free baking kitchen. Boys and girls of all
ages welcome. * If you would prefer your child to eat his or her cupcakes at home following
class rather than during our class please kindly send in a note with your child.
Instructor: Miss Brackett
Beachy Keen Fun
Grade level K-2
Is summer one of your favorite seasons? Do you love the beach? Come have fun learning all
about the beach! We’ll play water games, like Drip, Drip, Drop and Fill My Bucket. Our
projects will include shell paintings, collages, t shirt decorating and photo frames. We’ll read
summer stories and culminate our week with a make your own sundae party! Can you say I
LOVE SUMMER? Please pack a snack, drink and towel daily. Feel free to wear a bathing suit
under your clothes.
Instructor: Ms. DeTrolio
"Fun with Bee Bots and so Much More"
Grade level 2nd-4th
Technology activities have been planned in several academic areas, and will provide
opportunities for students to work beyond this week long class with some of the programs they
have used. Children will delight using our new Bee Bots, purchased with the generosity of
W.E.S.T.! Students will be presented challenges, much like those presented in our "Coding"
lessons. Students will program Bee Bots to answer questions they have been presented with,
and will become comfortable with basic programming commands. Next, students will
complete science and social studies challenges in: Moby Max, BrainPop Jr., Gizmos and
ABCYA! Scratch Jr. and Computer Drawing with Kid Pix 4 will also be taught. This class will
surely spark and keep your child’s interests.
Please e-mail Mrs. Traversi with any questions at: [email protected]
Instructor: Mrs. Traversi
Summer Science
Grade level- 2-5
Get ready for totally hands on, amazing science experiments. We will be exploding volcanoes, making
marshmallow towers, writing in invisible ink, creating homemade bouncy balls and much more! We will
discover what happens when you combine Diet Coke and Mentos, all the while learning what causes these
reactions. Don’t miss out on the fun!
Instructor: Miss Blake
Tennis and Pickleball
Grade level- 2nd -6th
Are your rackets ready? We hope so, because this summer we are offering a combined class of tennis and
pickleball! During tennis class we will be teaching all the basics such as forehand, backhand, volleys and
serves. The students will even participate in tournament play. Pickleball class will be structured similarly,
however the court size, racket size, and rules will change a bit! For those who do not know much about
pickleball, please check out this video! http://www.nbcnews.com/video/nightly-news/54713899 You will see
how closely related the two sports truly are. By the end of the week, we hope you grow a love for the games!
Instructors: Mrs. Pitman & Mr. Moon
Act it out!
Grade level- 2nd-6th
Do you like to perform? Do you enjoy being a part of a play? This is the program for you! Throughout the
week we will work together to create a play! Everyone will have a part in the play. We will rehearse lines and
work on stage performance. On Friday we will perform the play on stage!
Instructors: Ms. O’Connell & Ms. Downing
Scratch ll
Grade level 4th-6th
Both beginner and advanced students are welcomed back to learn more about Scratch in this follow-up course
to Scratch I. In this hands-on course, students will interact with the software to explore more features and gain
new skills. In addition to class instruction and free time to explore Scratch, the students will participate in
breaks from the computer screen and learn about various computer science topics. The students will create
either a game or animation that they may present on Friday.
Instructor: Miss Lopez
Reading Jump Start
Grade level- entering 7th
Set the perfect amount of time aside to prepare for 7th grade. Decide on which book to read, partner up with
some friends and work on your Active Reading Log throughout the week. We will develop a plan to make sure
you are on your way to a successful start to 7th Grade
If you are required to read 2 books, you can use the strategies you learn to continue on your own, or sign up for
another session.
Instructor: Mrs. Lopez
Session 3- July 10th-14th
Indoor/Outdoor Summer Play
Grade level- PreK-K
Come join in the fun with old friends and new. We will read stories, have snack, play indoor and outdoor
games, and create fun summer crafts! Don’t miss out on this one time offering!
Instructor: Mrs. Byrne
“Oh the Places We Will Go” Kindergarten Kickoff
Grade level- K
Calling all children entering kindergarten! Come and meet some of your future classmates! Learn your way
around the classroom and school. Give your child a JUMP START and help them KICK OFF a fabulous year
in kindergarten. Please join, Mrs. Buckley, Mrs. Traversi and Mrs. Williams as we introduce your child to
kindergarten here at the Delaney School. From arrival at the bus circle and until dismissal from the same spot,
we will follow a typical kindergarten schedule and routine. Children will rotate from their classroom learning
environment to other special subjects including, art, music, technology, and of course physical education!
This class will take place in the Vogel School. Children will have an opportunity to visit the art and music
classrooms where they will have class in the fall. Activities will be planned in both locations. Your child will
also have class in the computer lab located in the Vogel, and will have an opportunity to use some of the
programs they will be using throughout the school year. Finally, we will introduce your child to the awesome
Delaney Playground! We cannot wait to meet our future kindergarten students please consider joining us
Instructors: Mrs. Traversi & Mrs. Buckley
Pretty Jewelry
Grade level- K-6th
Do you love beautiful pieces of jewelry? Do you love the look of beaded necklaces and rope bracelets but
don’t know how to make them? This course is for you! We will use all different types of beads, thread,
paracord, and gems to create our own jewelry. Think about all of the accessories you could be wearing
throughout the summer or on your first day back to school: Necklaces, Bracelets, Rings, oh my!
Instructor: Miss Brackett
Cooking Creations
Grade level K-6th
Do you like to cook? Do you like sweets? We will be making yummy treats each day for you to take home.
Animal cupcakes, Jello oceans donuts, candy and much more, much more! This class will also include outside
playtime each day, reading books and doing crafts that go along with the food we make!!
Instructor: Mrs. Foxx
Jr. Detectives
Grade level K-3rd
During this exciting and mysterious class, the students will enjoy solving mysteries, playing iSpy, learning
how to spot objects in hidden picture puzzles and find hidden treasure. The students will work hard to create
their own treasure map and lead a friend with clues. We will have school wide treasure hunts and many
mysteries to solve. Throughout the week we will read about the mysteries of Cam Jansen and her
photographic memory and try to solve her mysteries.
Instructor: Ms. Walsh
Wilderness Survival
Grade level K-3rd
Calling all junior explorers! Join us as we dig into a week of wilderness skills and fun. We will make mini
survival kits to take home, build outdoor shelters, create bark boats, learn to whistle with acorns, and hike
around Sweatt Hill among other activities. Throughout the week we will learn to pack a daypack, practice safe
hiking, and use a compass. If you like the outdoors, you will love Wilderness Survival!
Instructor: Benson Colella
Creativity Unlimited!
Grade level 1st-6th
Have you heard about Wrentham's Destination Imagination program? Have you wondered, what's it all
about? During this week long program students will engage in similar activities to those found in the DI
program. Each day will start off with fun team building exercises, then move on to hands-on Instant Challenge
activities, like building a bridge with toothpicks and mini-marshmallows, or building a tower with spaghetti.
Students will be grouped together by grade and will experience the challenge of researching a given topic in
history and then rewriting that historical event in a new and creative way. Two sessions to choose from;
July 10 - 14 or July 17 - 21.
Instructor: Mrs. DeVore
Lego Science
Grade level 2nd- 4th
What could be more fun than building with Legos and experimenting with science at the same time?! How
creative can you be? We will build Lego marble mazes, balloon and rocket powered cars, catapults, and boats.
How fast and how far will your car go? How far can you make your catapult throw? How much weight will
your boat hold before it sinks? Let’s find out!
Instructor: Mrs. Amy Farrell
American Girl Club
Grade level 2nd – 4th
Do you love American Girl Dolls? If so, then this class is for you! Come bring your American Girl doll for a
week packed with fun. We will make crafts for you and your doll and end the week with an American Girl ice
cream party! So, grab your doll and come join the American Girl Cub!
Instructor: Ms. DeTrolio
A Yummy Twist to Science Camp
Grade level- 2nd- 6th
Have you ever wished you could experiment science with food? Now you can! Come join Miss White and
Mrs. Thorton as we explore the fascinating world of science with food and hands-on experiments. From
apples to marshmallows, the possibilities are endless! We’ve revamped the activities this summer and are
excited to explore with new foods and new activities. The week will be filled with explosions, launching
marshmallows, messy hands and many more! We hope to see you there! Please note that all materials are
nut free.
Instructors: Miss White & Mrs. Thorton
Minute to Win It!
Grade level-3rd-6th
Do you love fast-paced games? How about competing against friends or yourself to beat your personal best?
In Minute to Win It Challenge, we will use common household and school supplies to create exciting
challenges and games. Impress your friends with the tricks you master like knocking down a single pencil
with a marble, volleying paper balls with clipboards, and stacking and balancing dice on a Popsicle stick in
your mouth! On our last day, we hold our final Minute to Win It competition and the winning team will be
crowned the Minute to Win It Champions!
Instructor: Ms. Blake
Web Design
Grade level 4th-6th
Do you ever wonder how your favorite website is made? In this class, students will discover how to create and
design basic webpages. The students will participate in breaks from the computer screen to learn about various
computer science topics. By the end of the week, students will have their own website design.
Instructor: Miss Lopez
Summer Reading Jump Start
Grade level- entering 7th
Set the perfect amount of time aside to prepare for 7th grade. Decide on which book to read, partner up with
some friends and work on your Active Reading Log throughout the week. We will develop a plan to make sure
you are on your way to a successful start to 7th Grade
If you are required to read 2 books, you can use the strategies you learn to continue on your own, or sign up for
another session.
Instructor: Mrs. Lopez
Session 4- July 17th-21st
I Believe in Fairies!
Grade level PreK-3
DO you believe in fairies? We do! In this class we will explore the world of fairies (and maybe a gnome or
two.) We will read fairy stories and create little fairy dolls. When weather cooperates, we will spend time
outdoors to practice fairy dancing and build natural homes for our fairies with some teeny tiny
materials. Create another fairy house to bring home. Sprinkle on some pixie dust and join us for a fairy
filled week of fun!
Instructors: Deb Colella and Charlotte Colella
“Oh the Places We Will Go” Kindergarten Kickoff
Grade level- K
Calling all children entering kindergarten! Come and meet some of your future classmates! Learn your way
around the classroom and school. Parents, your child will have exposure to the kindergarten word wall words
and experience some new math activities. These lessons will be aligned with the state common core
standards. Give your child a JUMP START and help them KICK OFF a fabulous year in kindergarten.
Please join, Mrs. Stephanie Buckley, Mrs. Sue Traversi and Mrs. Faith Williams as we introduce your child
to kindergarten here at the Delaney School. From arrival at the bus circle and until dismissal from the same
spot, we will follow a typical kindergarten schedule and routine. Children will rotate from their classroom
learning environment to other special subjects including, art, music, technology, and of course physical
education! This class will take place in the Vogel School. Children will have an opportunity to visit the art
and music classrooms where they will have class in the fall. Activities will be planned in both locations.
Your child will also have class in the computer lab located in the Vogel, and will have an opportunity to use
some of the programs they will be using throughout the school year. Finally, we will introduce your child to
the awesome Delaney Playground!
We cannot wait to meet our future kindergarten students please consider joining us
Instructors: Mrs. Traversi & Mrs. Buckley
Fun With Water
Grade level K-1st
Do you love to play in the water? Then, this fun water camp for boys and girls is for you! Bring your flip
flops, bathing suit and towel, snack and plenty of water! We will play games is a small pool, slide down a
slip and slide, run under a sprinkler and hose, play fun water games and much more! Come have a SPLASH
of a time!
Instructor: Mrs. Byrne
The Beauty Salon
Grade level K-6th
Welcome back to the second annual beauty salon with Miss Brackett! Do you love getting your hair done?
Do you love painting your nails? Love playing with make-up? If you said yes to any of these questions then
this class is for you! At The Beauty Salon we will paint nails, learn new hairstyles, and even put on a
fashion show at the end of our week! Feel free to bring any of your own beauty accessories such as nail
polish, makeup, or hair pieces. Sign up quick because this class fills up fast! *Please kindly send in a note if
you prefer your child not to use certain materials such as hair chalk or makeup.
Instructor: Miss Brackett
Cooking Creations
Grade level K-6th
Do you like to cook? Do you like sweets? We will be making yummy treats each day for you to take home.
Animal cupcakes, Jello oceans donuts, candy and much more, much more! This class will also include outside
playtime each day, reading books and doing crafts that go along with the food we make!!
Instructor: Mrs. Foxx
Seussical Summer
Grade level K-2nd
It’s only just begun, Come on in and join the fun. We’ll learn about Horton, That’s for certain. Sit back and
relax, as we read the Lorax. How about some some Oobleck? You’ll think it’s so coolbleck. You’ll surely be
beggin’, To taste those green eggins. We’ll make one fish, two fish swimming in the sea, And after that, we’ll
plant a tree! Yes! Dr. Seuss, he is the one, you don’t want to miss the fun!
Instructor: Miss Blake
Perler Beads and More!
Grade level K-3rd
Students will get together to create different designs with perler beads. They will be able to share their
creations with the group and get ideas for their own. Each day we will have a different theme with different
patterns that will be available. We will also work on a new craft each day!
Instructor: Ms. Walsh
Games Galore!
Grade level- 1st -4th
Do you love to play games? Come and hang out with your friends, play some of your old favorites and learn
some new ones too. Board games, card games, brain games, movement games, challenge games (e.g. Minute
to Win it), the sky is the limit. We will try them all! Do you have a favorite game? You can bring that too.
Instructor- Mrs. Amy Farrell
Creativity Unlimited!
Grade level 1st-6th
Have you heard about Wrentham's Destination Imagination program? Have you wondered, what's it all
about? During this week long program students will engage in similar activities to those found in the DI
program. Each day will start off with fun team building exercises, then move on to hands-on Instant Challenge
activities, like building a bridge with toothpicks and mini-marshmallows, or building a tower with spaghetti.
Students will be grouped together by grade and will experience the challenge of researching a given topic in
history and then rewriting that historical event in a new and creative way. Two sessions to choose from; July 10
- 14 or July 17 - 21.
Instructor: Mrs. DeVore
Legos! Legos! Legos!
Grade level 2nd-6th
Calling all Lego builders! Come and explore the wonderful world of bridges, skyscrapers, planes and more
with Legos! Each session will be focused on building different structures, learning creative Lego building
techniques and other activities involving the exciting uses of Legos. Legos will be provided, but students may
also bring in their special Legos from home. Students will uses their imagination to recreate or envision their
own structures. Come and discover all you can do with Legos.
Instructors: Miss White & Mrs. Thorton
Insane Science
Grade level 3rd- 6th
Just as Einstein said “Play is the highest form of research”, so In this class we will be doing fun and crazy
science experiments and having fun at the same time! We will be learning about chemistry by creating Lava
Lamps, and rock crystals. We will explore life science by making our own fossils. We will even learn about
biology by extracting DNA from peas! On the last day we will do a fascinating experiment that will blow
your mind!! So grab a friend and join this class for some INSANE SCIENCE!
Instructor: Ms. DeTrolio
PROGRAMMIN' PROS
Grade level 4th-6th
In this introductory class, students will learn basic syntax for the programming language Python. In addition to
creating their own first programs, they will learn how languages like this one are utilized to build apps and
games. After class instruction free time on the computer will allow the new programmers to discover Python for
themselves. The students will participate in periodic breaks from the computer screen to learn about various
computer science topics, participate in logic games, work with algorithms, and learn about well-known
individuals and their technological breakthroughs.
Instructor: Miss Lopez
Summer Reading Jump Start
Grade level- entering 7th
Set the perfect amount of time aside to prepare for 7th grade. Decide on which book to read, partner up with
some friends and work on your Active Reading Log throughout the week. We will develop a plan to make sure
you are on your way to a successful start to 7th Grade
If you are required to read 2 books, you can use the strategies you learn to continue on your own, or sign up for
another session.
Instructor: Mrs. Lopez
Wrentham Summer Institute 2017 Registration Form
Child’s Name:________________________________________Grade Fall ‘17____________
Street City State Zip
Parent’s Name:_________________________Home Phone:_____________Cell#_________
Email: _____________________________________________________________________
SESSION 1: June 26th-30th
Course Name Extended Day
12:00-4:00
1st Choice
Yes- hours needed
2nd Choice
No
SESSION 2: July 3, 5, 6,7
Extended Day
12:00-4:00
1st Choice
Yes- hours needed
2nd Choice
No
SESSION 3: July 10th-14th
Extended Day
12:00-4:00
1st Choice
Yes- hours needed
2nd Choice
No
SESSION 4: July 17th-21st
Extended Day
12:00-4:00
1st Choice
Yes- hours needed
2nd Choice
No
Total # of sessions_____________________x $100 = Total Payment Due. Beginning June 1st, class fee is $ 105 – Beginning July 1st, class fee is $ 110
Please make checks payable to: Wrentham Public Schools
Mail registration form, medical form and payment to:
Wrentham Summer Institute- Roderick School- 120 Taunton Street- Wrentham, MA 02093
Date Received: Check # : Amount:
Wrentham’s Summer Institute 2017 Emergency Medical Form
Child’s Name: ______________________________________________Grade Fall ‘17____________
Street City State Zip
Parent’s Name:_________________________ Home Phone: _________________________
Cell Phone: ___________________________ Work Phone: __________________________
Please identify a contact in case of emergency when parent or guardian cannot be reached:
____________________________________________________________________________
Name Relation
____________________________________________________________________________
Home Phone Work Phone Cell Phone
Medical Information
Family Doctor: Telephone Number:
Family Dentist: Telephone Number:
Preferred Hospital
Insurance Provider:
Please identify any allergies, daily medications, or health problems your child has that we should be
aware of.
The above named has my permission to participate in the Wrentham Summer Institute 2017. I understand and accept the
condition that any member of the staff will not be held responsible for accidents, medical, or dental expense that are
incurred as a result of participation in this program. I further release the Wrentham Summer Institute 2017 and the
Wrentham Public Schools/Town of Wrentham from any and all claims.
I also understand that by signing below, I give the Wrentham Summer Institute permission to share this information with
staff and emergency personnel.
____________________________________________________________________________
Parent/Guardian Signature Date
This form MUST be retuned along with the registration form. If you are NOT a Wrentham student, please send a copy
of your current physical form including immunizations from your doctor.