Virtual Summer School Registration Form 2017
Student's First Name *
Your answer
Student's Middle Name
Please include for student identification/grade reporting purposes
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
mm/dd/yyyy
MM
/
DD
/
YYYY
Student's Gender
Student's School *
Non-LPSS School Name (If Non-LPSS School selected above)
This information is required for enrollment into Summer School
Your answer
Student's School ID Number
Your answer
Student's Current Grade Level *
Student's Parent/Guardian First Name *
Your answer
Student's Parent/Guardian Last Name *
Your answer
Street Address *
Your answer
Lot/Apt. #
Your answer
City *
Your answer
Zip Code *
Your answer
Parent Phone Number -- Primary *
10-digit phone number -- include dashes (Ex. 337-555-5555)
Your answer
Parent Phone Number -- Secondary *
10-digit phone number -- include dashes (Ex. 337-555-5555)
Your answer
Parent Phone Number -- Alternate
10-digit phone number -- include dashes (Ex. 337-555-5555)
Your answer
Emergency Contact Phone Number *
10-digit phone number -- include dashes (Ex. 337-555-5555)
Your answer
Parent's Email Address -- Primary
Your answer
Parent's Email Address -- Secondary
Your answer
Special Education or 504 Accommodations *
Were Special Education and/or 504 Accommodations provided during the regular school session?
NCAA Eligibility Requirements *
Will this course be used to satisfy initial NCAA eligibility requirements?
Parish *
Please select the Parish that your child's school is located in
Course Request *
Please indicate the course the student failed and needs to retake.
Session *
Please indicate which session you would prefer: Morning Session (7:30 AM - 10:30 AM) or Afternoon Session (12:00 PM - 3:00 PM)
Alternative Course Request
In the event the student failed two courses and the course requested above is full, please indicate the second course request.
Session
Please indicate which session you would prefer: Morning Session (7:30 AM - 11:00 AM) or Afternoon Session (11:30 PM - 3:00 PM)
Summer School Tuition Fees *
Tuition must be made in person at Northside High School on May 27, May 31, or June 1. Accepted forms of payment are Cash or Credit Card.
Students are required to furnish headphones on June 2, when classes begin.
Summer School Policy Acceptance *
By clicking "Accept" below, I attest that I have read and understand the rules of the Summer School Program concerning the curriculum, attendance, discipline, etc. I agree to abide by these regulations. There will be NO TUITION REFUNDS once a student has been assigned and a teacher employed.
Required
Signature of Parent *
Please type in your full name.
Your answer
Submit
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