Summer School Registration Form
(Summer 2019)



Directions: Please fill out the form below, click "Continue" to review information you entered, and then click "Submit" to submit your Summer School registration information to the school. A registration is not complete until you have hit "Submit" on the second screen and received a registration number.


Student and Parent Information

Student Name
     Student ID
     Grade Level (9,10,11,12)
Parent/Guardian Name
     Guidance Counselor
Address
     City, State, Zip
Home Phone
     Parent Cell Phone
     Parent Email

Is this student eligible for free/reduced lunch?     Yes     No


Emergency Contact Information

Name
     Relationship
     Phone


Fill in below if English Language Arts (ELA) is needed

ELA Course Name
     ELA Course Grade Level (9,10,11 or 12)


Fill in below if Math is needed

Math Course Name
     Math Course Grade Level (9,10,11 or 12)


Fill in below if Science is needed

Science Course Name
     Science Course Grade Level (9,10,11 or 12)


Fill in below if Career Preparation and Planning is needed

Technical, Related, or Other Course Failed
     Course Grade Level (9,10,11 or 12)
  attending summer session to receive course credit
-OR-
  attending summer session to receive course credit and meet attendance requirement


Transportation

  Student LRTA Bus Pass requested
-OR-
  Student will provide own transportation