Summer School 2017 Registration
**Please note you will receive a confirmation email when the counselors have approved your enrollment. Upon receipt of the email AND payment of your tuition your registration will be official. PLEASE read the registration bulletin, rules, and regulations BEFORE filling out this form.
Last Name, First Name (ex. Smith, Chris) *
Your answer
address *
Your answer
Parent/Guardian Phone Number (where we may contact you during the day)
Your answer
Email where we may send your confirmation. This email will also be used to email you weekly progress updates. *
Your answer
Summer School classes are for *
Session student will attend *
morning is 8:15-11:15, afternoon is 12:15-3:15. Please note if attending both sessions, lunch will be on your own.
Courses Requested *
Students may not take more than two courses, only one course will be permitted if the student is taking a math class
- Please list two additional emergency contacts, their phone numbers, and relationship to child in the event of an emergency during summer school.
Your answer
I hereby give consent for the following medical care providers and local hospital to be called. (Please give physician name and phone, dentist name and phone, and local hospital/ER phone)
Your answer
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by above-named physician/dentist, or, in the event the designated preferred practitioner is not available, by another licensed physician/dentist; and (2) the transfer of the child to any hospital reasona-bly accessible.This authorization does not cover major surgery unless the medical opinions of two (2) other licensed physicians/dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.Facts concerning the child's medical history including allergies, medications being taken, and any physical impairments to which a physician should be alerted. (please type your name and date below to acknowledge this statement)
Your answer
Please type your name and your student's name to acknowledge receipt of Summer School Rules and Regulations.
Rules and regulations are listed in the summer school brochure. Please note, school dress code will be strictly enforced. Additionally, the library is VERY COLD in the summer. Please bring appropriate clothing.
Your answer
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