* Required

Welcome to the Project SHARE 2023 Summer Program for the Bella Vista Elementary School & RSTEM Academy!

Student Information

Which week(s) will your child attend the Bella Vista & RSTEM Academy summer program? ​
MM/DD/YY​​
Please answer the following questions so that we may care for your child to the best of our abilities:
Ethnicity: Check all that apply:​​​​​
Swimming will be offered during the Project SHARE summer program. All swimming activities are done under the supervision of a certified lifeguard. Please check all that apply.​
Does your student need to wear a life jacket when swimming?​​
WES (Whiskeytown Environmental School) Permissions:
As part of the activities at the WES sponsored events/camps, we give the children the choice of tasting some of the edible plants in the area, i.e., Manzanita berries, wild onions, and Douglas fir needles. Some parents have expressed that they are not comfortable with this. Please indicate your preference.
We may tie-dye during summer camp. WE will let you know beforehand. You may bring a white or light colored t-shirt from home to tie-dye.
If documentation is required to be on file for allergies, medications, alerts / restrictions,  behavior plan, etc., it must be updated each year by the parent. An option at the end of the questionnaire is available for uploading.
 
If you prefer, please email to ProjectShareInfo@shastacoe.org. Please include the child's name and site within the body of the email.

In case of Emergency *FIRST CONTACTS*

Custodial parent / guardians will be notified first in an emergency or for a discipline issue. This individual has pick up authority by default. Please list an alternate choice if custodial parent/guardian cannot be reached. 

Custodial Parent/Guardian:

Custodial Parent/Guardian:

Child may be picked up by:

Child may NOT be picked up by:

If documentation is required to be on file to prohibit certain individuals from picking up the child(ren) your are registering it must be updated each year by the parent. An option at the end of the questionnaire is available for uploading.

If you prefer, please email to ProjectShareInfo@shastacoe.org. Please include the child's name and site within the body of the email.

Medical/Miscellaneous Information

Please attach the file for any documentation that needs to be on file. This must be done annually to ensure we have the most current information.
Max file size: 10 MB

Please provide an email address where we can send a link to your current form.

Email Address :