Summer School Registration Form
Student Name
Your answer
Student Date of Birth
MM
/
DD
/
YYYY
Age
Your answer
Sex
Known Medical Concerns
Your answer
Medications
Your answer
School for 2020-2021 School Year
Your answer
Grade for 2020-2021 School Year
Address of Student
Your answer
Student Email Address
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian Home Phone
Your answer
Parent/Guardian Work Phone
Your answer
Parent/Guardian Cell Phone
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone
Your answer
Relationship to Student
Your answer
Insurance Carrier *
Your answer
Policy Number *
Your answer
Address and Phone Number of Insurance Carrier *
Your answer
The school has my permission to take my child to the nearest hospital in an emergency. The medical staff of the hospital has my consent to provide treatment for my child. In addition, I have read and agree to the policies outlined surrounding Summer School attendance and behavior. *
Signature of Parent/Guardian Agreeing to Treatment *
Your answer
Summer School Logistics
Name of Term 1 AM Course (indicate which semester or if this is a full term course)
Your answer
Is this an ACCESS course? ACCESS is an online learning experience managed by the Alabama State Department of Education in conjunction with local schools. ACCESS classes may be entirely online or be conducted via teleconferencing. All test/assessments must be completed in the presence of a school facilitator.
Is this for credit recovery or initial credit/credit advancement? Credit Recovery is defined as the need for a student to repeat a course to complete the requirements to obtain credit for that course. Eligibility depends upon the student’s failing grade in their original course. Students with grades lower than a 40 are not eligible for credit recovery, instead must repeat the entire course.
Name of Term 1 PM course (indicate which semester or if this is a full term course)
Your answer
Is this an ACCESS course? ACCESS is an online learning experience managed by the Alabama State Department of Education in conjunction with local schools. ACCESS classes may be entirely online or be conducted via teleconferencing. All test/assessments must be completed in the presence of a school facilitator.
Is this for credit recovery or initial credit/credit advancement? Credit Recovery is defined as the need for a student to repeat a course to complete the requirements to obtain credit for that course. Eligibility depends upon the student’s failing grade in their original course. Students with grades lower than a 40 are not eligible for credit recovery, instead must repeat the entire course.
Attendance Policy
Behavioral Expectations
By submitting this form, you/your child agree to abide by the policies established in this form. *
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