Winter School 2020 Registration
Student First Name *
Your answer
Student Last Name *
Your answer
Student ID Number
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
PARENT Name *
Your answer
PARENT Phone Number ###-###-#### *
Your answer
PARENT Email Address
Your answer
STUDENT Phone Number ###-###-#### *
Your answer
STUDENT Personal Email Address *
If Scranton School District student: please use your SSDEDU email account
Your answer
Does the student receive Special Education Services? *
MARK ONLY 1
Is the student an EL Learner *
MARK ONLY 1
School the student currently attends *
Your answer
Grade the student is currently in *
2019 - 2020 School Year
Next
Never submit passwords through Google Forms.
This form was created inside of Scranton School District. Report Abuse