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2022 Park Crossing Promotional Summer School Registration
Promotional Summer School students are permitted (2) emergency absences. Additional absences from Promotional Summer School will result in Automatic failure.
* Indicates required question
Email
*
Your email
Student Name (Last, First)
*
Your answer
Student ID Number (Same as # in student email)
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Your answer
Current Grade
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9
10
11
12
Date of Birth
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MM
/
DD
/
YYYY
Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Parent/Guardian 1
*
Your answer
Parent/Guardian 1 Cell
*
Your answer
Parent/Guardian 1 email
*
Your answer
Parent/Guardian 2
Your answer
Parent/Guardian 2 Cell
Your answer
Parent/Guardian 2 email
Your answer
Does student receive Special Education Services during the school year?
*
Yes
No
Does student receive 504 Services during the school year?
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Yes
No
Person 1 Pick Up (parental permission to pick up the student) Name, relationship to student, cell number)
Your answer
Person 2 Pick Up (parental permission to pick up the student) Name, relationship to student, cell number)
Your answer
Permission to Walk Home: By checking yes, you are giving your student permission to sign himself/herself out to walk home from school at the conclusion of the Promotional Summer School day.
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No
Yes
Emergency Contact 1 Name, relationship, number
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Your answer
Emergency Contact 2 Name, relationship, number
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Your answer
Any known medical issues?
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Yes
No
Describe medical issues (allergies, nosebleeds, etc.) Type None if no medical issues
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Your answer
Physician Name, Number
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Your answer
In case of an emergency, the Promotional Summer School staff has my authorization to secure medical attention for my child.
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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