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NRESC Wayne Valley Summer School Pre-Registration form
Male or Female?
Parent Cell Phone
Parent Home Phone
Emergency Contact Name and Phone Number
Sending School Name
Sending School Address
Sending School Phone Number
Last Grade Completed
Do you receive supplemental help during the regular school year? Please check all that apply
Does the student have any additional needs for specialized or support services? (If yes, IEP/504 must be attached to registration forms)
Will your child be taking remedial courses or accelerated courses?
Course 1 (subject and grade level)
Course 2 if applicable (subject and grade level)
Authorization of sending school: Credit may not be awarded without the approval of the sending school. Please provide the name of the Principal/Guidance Counselor approving the course. (Note: You will need a signature of the school official in order to enroll in accelerated/remedial courses)
Note to counselors: For students taking Algebra 1, Algebra II, Geometry, English 1, English 2, or English 3, please share the information in this document (
PARCC acknowledgement (Please check all to complete registraction)
My guidance counselor knows I am taking a math course (Algebra 1, Algebra 2, or Geometry) or english course (English 1, English 2, or English 3)
I understand that I will need to take the PARCC in order to complete the program and earn a grade for the course
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