Summer School Student Enrollment

At the end, you will need to be sure and hit the SUBMIT button for your registration to be complete!!!
Please contact Jan Dempsey if you have any questions at jdempsey@mexico.k12.mo.us or
573-581-3773 x2404. YOU WILL NOT GET AN EMAIL VERIFYING YOU HAVE SUBMITTED THIS
ENROLLMENT.

Student First Name *
Your answer
Student's Middle Name
Your answer
Student's Last Name *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
#1 Phone Number *
Your answer
#2 Phone Number
Your answer
Gender *
Student's Date of Birth *
MM
/
DD
/
YYYY
IEP - Does your student have an IEP?
Current School Attending *
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