2019 Summer School Registration Form
Please complete all fields.
Student Information
Student Name: (Last Name, First Name, M.I.) *
Your answer
Address: (Street/Box # ) *
Your answer
City, State & Zip *
Your answer
Current Grade Level: (2018-2019 School Year) *
Gender: *
Date of Birth: *
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Student E-Mail Address: *
Your answer
Parent Information
Parent/Guardian Name: (Last, First, M.I.) *
Your answer
Parent Address: (Street/Box #) *
Your answer
City, State & Zip *
Your answer
Parent E-Mail Address: *
Your answer
Home Phone Number: *
Your answer
Cell/Work Phone Number: *
Your answer
Payment Options:
$190.00 Per Course, 1/2 of Course Fee ($95.00) must be submitted to the HS Main Office by June 20, 2019 by 3:30 PM. Checks can be made payable to: NEWPORT SCHOOL DISTRICT. Payment plans are available to families in need. Please contact Carla Ebling at (717) 567-2517 to discuss payment plans.
Payment *
Amount of Deposit/Payment: *
Your answer
Course Selection for Summer School
Course(s) selected for summer school must have the approval of a counselor or a principal. Please see Information Sheet for available courses.
Course #1:
Preferred Time of Course #1:
Course #2:
Preferred Time of Course #2:
Confirmation
I understand I must arrange for transportation and I understand the information and attendance policy outlined in the attached Student and Parent Information Sheet.
Parent/Guardian Acknowledgement (Name) *
Your answer
Date: *
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Student Acknowledgement (Name)
Your answer
Date: *
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