Summer School Registration Form 2018
Student LAST Name *
Your answer
Student FIRST Name *
Your answer
Student ID Number *
[If you are coming from outside LUSD please insert the number zero (0)]
Your answer
Grade as of September 2018 *
List the grade you will be in NEXT school year
Street Address *
(ex: 123 Main Street)
Your answer
City *
(ex: Mountain House)
Your answer
State *
Your answer
Zip Code *
Your answer
School Currently Attending *
Does your child have a medical condition that summer school staff should be aware of? *
If your child DOES have a medical condition, please list specifics here
(Only if your student HAS a medical condition we need to be aware of)
Your answer
Summer Course Selection
Please refer to your student's MHHS Summer School 2018 letter for any required or recommended courses. All course registrations made prior to the start of summer school will be reviewed for accuracy by your student's assigned counselor.

Please identify the courses you would like to take during summer school. Each course counts for 5 credits (one semester). You may choose up to two courses (total of 2 semesters) now. If you complete these courses you may have the opportunity to take other courses. Please remember our request of $50 per course to help defray the costs of the summer school program.

First Course Selection
5 credit, 1 semester courses
Second Course Selection
5 credit, 1 semester courses
Emergency Information
Please provide emergency contact information for your student in case of any emergency.
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email Address *
Your answer
Parent Guardian Name
(Optional 2nd Parent/Guardian)
Your answer
Parent/Guardian Phone Number
(Optional 2nd Parent/Guardian Phone Number)
Your answer
Parent/Guardian Email Address
(Optional 2nd Parent/Guardian Email Address)
Your answer
Additional Adult(s) authorized to pick up student
Please provide name(s) and phone number(s) of students authorized to pick up student.
Your answer
Doctor's Name *
Your answer
Doctor's Phone Number *
Your answer
By typing my full name here I acknowledge that I have read and understand the policies and regulations of summer school. *
Please type the parent/guardian's full name here
Your answer
SUMMER SCHOOL PAYMENT REQUEST
LUSD has provided this opportunity for students to recapture credits during summer school. State funding no longer exists for summer school programs, and your payment of $50 per class taken this summer helps our district to continue opportunities for remediation. Please visit our webstore and click on "summer school payment" to make your donation.
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