dMHS Summer Enrichment Registration Form
Summer Enrichment will be from 9:00-12:00 pm on the following dates: July 10, 12, 17, 19, 25, 26, 31 and August 2, 7, 9.

The goal is to provide a resource for all students to improve, enhance, and refine academic skills. Signing up for summer enrichment is a true commitment. We want to make sure all students are dedicated to coming for each session, especially since the number of students able to participate will be limited.

Please fill out the form below as completely as possible. We will use this information to ensure your student is placed in the appropriate summer enrichment class(es). If you have questions, feel free to contact Mina Todd at mina.todd2@jefferson.kyschools.us.

Email address *
Student's name *
Your answer
Student's middle school (If student attended dMHS last year, leave blank.)
Your answer
Parent/Guardian's name *
Your answer
Parent/Guardian contact information (phone number and email address) *
Your answer
Academic placement for summer enrichment (You may choose more than one if needed.) *
Required
For the academic placement chosen above, please tells us about the particular skills in which your student needs additional support. (e.g. English- my student needs additional support in answering reading comprehension questions.) If you are not sure, you may leave this blank.
Your answer
Student's allergies or medical concerns (if applicable)
Your answer
Emergency contact (name and phone number) *
Your answer
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