2017 HIGH SCHOOL Summer School Registration Form
The Summer School policy states that students must earn at least a 50% Final Average in the class they wish to take in Summer School. They may take up to 3 classes if their schedule allows (pending schedule offerings). Students will be contacted via email with confirmation that they have been enrolled. Students can also register to retake Regents Exams that they have not passed. Regents exam dates are August 16&17, 2017.
Student Last Name
Your answer
Student First Name
Your answer
Counselor Name (this form is for High School Registration only)
The following are the high school level summer courses that I would like to take:
Required
Student Grade Level for next year (17-18)
Student Cell Number
Your answer
Student E-mail
Your answer
Student Address
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian Telephone
Your answer
Parent/Guardian E-mail
Your answer
SUMMER SCHOOL HEALTH RECORD: (This part must be filled out out in its entirety)
Are there any allergies to medications? If so, what medications?
Your answer
Are there any environmental or food allergies?
If so, please explain.
Your answer
Asthma?
If so, please explain.
Your answer
Are there any medical conditions requiring special attention?
If so, please explain.
Your answer
Is prescription medication taken regularly?
If so, please explain.
Your answer
I have read and agree to the Summer School rules and regulations outlined in the Summer School pamphlet.
By placing your initials in the box, you agree to the Summer School rules and regulations.Your Guidance Counselor will certify that you are eligble to take the courses/exams listed above and will register you accordingly. You will be contacted via email or phone.
Your answer
The code of conduct applies in summer school. Violations may result in the dismissal of summer school and no credit will be given.
Please sign that you acknowledge that all rules will be followed in summer school
Your answer
I acknowledge that I can not miss more than three (3) summer school days. If I miss 4 days, I will be dropped from summer school.
please initial
Your answer
If transportation to summer school was available in the future, would you use this service?
FOR OFFICE USE ONLY: Schedule Created by Counselor
Your answer
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