Summer School Enrollment Form 2019
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Summit High School Summer School Registration Form 2019
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STUDENT INFORMATION
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Student's Last Name Student's First Name Student's Middle Name: Age:Grade:Gender:
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Date of Birth (Month/Day/Year) Student's email address:Student's Cell Phone
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SCHOOL INFORMATION
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Name of School Attended During School YearSchool Location (City, State, Zip Code, if known)
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PARENT/GUARDIAN/ADULT STUDENT (over 18) INFORMATION
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Primary Contact: Name (Last, First)___ OK to pick-up ___ Legal Custody ___ Lives with ___ Receives MailingsSecondary Contact: Name (Last, First)___ OK to pick-up ___ Legal Custody ___ Lives with ___ Receives Mailings
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Home AddressHome Address
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City State Zip CodeCity State Zip Code
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Mailing Address (if different from above)Mailing Address (if different from above)
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City State Zip CodeCity State Zip Code
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Home Phone (____Primary #)Work Phone (____Primary #)Home Phone (____Primary #)Work Phone (____Primary #)
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Cell Phone (____Primary #)Relationship to StudentCell Phone (____Primary #)Relationship to Student
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Email Address: Email Address:
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IN CASE OF EMERGENCY NAMES OF PERSONS OTHER THAN PARENT WHO CAN ASSUME TEMPORARY RESPONSIBILITY
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Emergency Contact 1 Name (Last, First) - Person that can Pick up StudentEmergency Contact 2 Name (Last, First) - Person that can Pick up Student
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Home PhoneWork PhoneHome PhoneWork Phone
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Cell Phone Relationship to StudentCell Phone Relationship to Student
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PLEASE LIST SIBLINGS
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Names (Last, First) AgeSchool
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TO THE BEST OF MY KNOWLEDGE THE INFORMATION I HAVE PROVIDED ON THIS FORM IS ACCURATE AND TRUE. (FALSIFICATION OF INFORMATION IS A CLASS 6 FELONY - A.R.S. 13-2-107) STUDENT WILL BE WITHDRAWN FOR FALSE INFORMATION
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X
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PARENT / GUARDIAN / ADULT STUDENT SIGNATUREDATE
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What school is student planning on attending during the 2019-2020 school year?
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728 E McDowell Road, Phoenix, Arizona 85006 602.258.8959 www.summiths.com
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Summit High School - Summer School 2019
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Students are able to participate in one class per session. Perfect attendance is required for students to receive .5 credit for a class. Lunch items will be provided daily for free. Classes are a total of ten days, Monday-Friday. Place an “X” next to the class you want to attend. If a student misses more than one hour of any class for any reason, they will not be able to earn credit. No accommodations will be made. Do not sign up for classes if you know you have a prior appointment. Classes are from 8:00 AM - 2:35 PM (Lunch: 11:30-11:50). Any discipline issues will not be tolerated, and students will be removed. Discounted bus tickets for Valley Metro Bus service are available upon request.
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Summer School Session #1: June 3 - June 14
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English 10-1 (Boumerzoug)
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English 12-1 (Stafin)
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Geometry 1 (TBA)
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Computer-Based (Cassano)
Choose a class from the list below
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Subject: Subject:
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English CreditMath CreditSocial Studies CreditScience Credit Elective Credit Fine Arts Credit
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English 9-1Algebra 1-1American History BiologyPersonal FitnessArt History
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English 10-1Algebra 2-1Economics Earth Space SciencePhysical EducationMusic Appreciation
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English 11-1Geometry 1GovernmentPhysical ScienceSpeech
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English 12-1Pre-Calculus 1World History
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English 12-2
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If a specific course is not listed, please write the course title here: __________________________________________________________
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The course will need administrative approval.
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Summer School Session #2: June 17 - June 28
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English 11-1 (Boumerzoug)
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Senior Math (Lupien)
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Statistics (Rodriguez)
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Computer-Based (Stafin)
Choose a class from the list above
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Subject: Subject:
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If a specific course is not listed, please write the course title here: __________________________________________________________
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The course will need administrative approval.
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Each computer-based class is worth .5 credit. Example: Finish English 12-1 and English 12-2 earn one credit for Senior level English.
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