2017 Blended Summer School CPE/MIS
This form is only used for BLENDED Summer School registration. If you are registering your child for traditional summer school, please use the Traditional Summer School form.

Blended Summer School is a technology driven program in which students only attend classes 1/2 day per week (about 3 hours). The majority of work and learning take place at home. The program revolves around enriched technology projects; general education subjects such as reading and math will not be emphasized. If your child needs continued practice in subjects such as reading and math, please complete the Traditional Summer School application.

Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's current grade level *
Student's Current Homeroom Teacher
Leave field blank if you don't know
Your answer
Parent or Guardian name(s):
Your answer
Parent or Guardian Email Address:
Your answer
Please list cell phones and home phone numbers. *
Include any number that would be useful should we need to contact you in case of an emergency.
Your answer
I would like to sign my child up for Band Summer School and Blended Summer School. *
Band Summer School is available for current 5th/6th grade students only.
Students will need to be on campus once a week for three and a half hours. Please select which day and time would best fit your family's needs. *
If your first choice in class time is no longer available, what would your second choice be?
How will your child get to and from summer school each day? *
List any medical or allergy information:
Please list any daily medications that your child will take at school.
Your answer
Do you have any concerns either academic or behavioral? If yes, please explain:
Your answer
Does this child have sibling(s) signed up for other Blended Summer School classes? *
Would you like your children to be in class at the same day / time?
Does your child receive special services? *
Any additional comments:
Your answer
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