Mountain Home Summer School Enrollment Form
Please provide the following information.
Student Last Name *
Your answer
Student First Name *
Your answer
Mailing Street Address *
Your answer
City, State & Zip Code *
Your answer
Student Birthdate *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
Parent / Guardian Name *
Your answer
Parent / Guardian Contact Number *
Your answer
Parent / Guardian Email Address
Your answer
Name of the last school the student attended *
Your answer
What was the student's grade level in the 2017-2018 school year? *
Was the student on any of the following in the previous school year? *
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