Mt. Zion Summer School Registration Form HS Courses
Please provide as much information as possible. Please use standard capitalization or all caps - this will be used for all mailing labels.
Student First Name *
Your answer
Student Middle Name
Your answer
Student Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Gender *
Date of Birth *
MM
/
DD
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YYYY
Does the student have an IEP (Special Education) or 504 (Accommodations for a Disabling Health Condition)? *
The Mt. Zion Grade office must receive a current valid copy of the "Accommodations" page of the IEP or 504 for accommodations to be implemented. Out-of-District 504 accommodations are subject to approval of the Mt. Zion School District.
Parent/Guardian First and Last Name *
Your answer
Parent Email Address *
E-mail is an important communication tool for Summer School.
Your answer
Parent/Guardian Phone # 1 *
Please provide the best number to contact you during the day.
Your answer
Parent/Guardian Phone #2
Your answer
Parent/Guardian Phone # 3
Your answer
Emergency Contact First and Last Name: *
If we cannot reach the parent/guardian, who should we contact in an emergency?
Your answer
Emergency Contact Phone #1: *
Please provide the best daytime phone number.
Your answer
Emergency Contact Phone # 2
Your answer
Emergency Contact Street Address *
Your answer
Emergency Contact City, State, Zip *
Your answer
Does the student have a chronic illness or other critical health issue? *
If yes, please complete and submit a health form.
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