Request edit access
2026 Secondary  Summer School Registration Form
Dates: Monday, July 6, 2026 - Thursday, August 13, 2026
*There will be NO Summer School on Friday July 17th, Friday July 24th, Friday July 31st, and Friday August 7th.

Time: 7:00 am - 11:30 am Secondary

The 2026 Summer School Program will be in-person  at East Main Elementary and focus on providing opportunities for our students to practice skills, receive support and take part in standards-based programs.  

 Please complete the form for registration.

Sign in to Google to save your progress. Learn more
Email *
I understand that summer school will be in person at East Main Elementary and there will not be a remote option. *
Student Last Name *
Student First Name *
The following are the middle school level summer courses that I need to take. *
Required
I am a bus student during the school year, and I will require bussing during summer school. *
Student current address *
Parent/Guardian Name *
Parent/Guardian Telephone (cell phone) *
Parent/Guardian E-mail *
SUMMER SCHOOL HEALTH RECORD: (This part must be filled out out in its entirety) *
Does the student have any allergies to medications? If so, what medications? (write "none" if there are no allergies)
Does the student have any environmental or food allergies? *
If so, please explain. (Write "no" if there are no food allergies.)
Does the student have asthma? *
If so, please explain.  (Write "no" if student does not have asthma.)
Are there any medical conditions requiring special attention? *
If so, please explain.  (If none, write "N/A" for not applicable.)
Is prescription medication taken regularly? *
If so, please explain. (If none, write "N/A.")
The code of conduct applies in summer school. Violations may result in the dismissal of summer school and no credit will be given.   *
Please put your name below indicating that you acknowledge that all rules will be followed in summer school.
I acknowledge that I can not miss more than three (3) summer school days.  If I miss four (4) days, I will be dropped from summer school and may be retained in my current grade level.  (This includes excused and unexcused absences.) *
please initial
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Port Jervis City School District.

Does this form look suspicious? Report

Google Forms