Summer School Registration 2019
Please fill in all fields to register for summer school. Registration is not complete until payment is received in the form of a check or through Pushcoin in mid-April. Courses that do not meet minimum enrollment requirement will be cancelled in mid-May.
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Grade in 2019-20 *
Your answer
Student's School in 2018-19 *
Your answer
Student's Home Phone Number *
Your answer
Student's Street Address *
Your answer
Student's Town *
Your answer
Guardian/Parent Name *
Your answer
Guardian/Parent Phone Number *
Your answer
Guardian/Parent Email Address *
Your answer
Emergency Contact & Relationship to Student *
Your answer
Emergency Contact Phone Number *
Your answer
Student Medical Conditions & Allergies
Your answer
At dismissal student will *
List the Course Name of the 1st Class You'd Like. *
Your answer
List the Section Number of the 1st Class *
Your answer
Would you like another course? *
Next
Never submit passwords through Google Forms.
This form was created inside of Riverside Public Schools District 96. Report Abuse - Terms of Service