Findlay High Credit Recovery School Summer School Registration 2022

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This registration form must be fully complete before it can be processed. #TrojanTrue

Email *

Student's First Name *

Student's Last Name *

Phone Number *

Address *

City *

Zip Code *

Email *

Age *

Date of Birth *

YYYY

ESL Student (English as a Second Language) *

Yes

Are you currently on an Individualize Education Plan (IEP)? *

Yes

Grade Completed in 2021/2022 *

Freshman

Sophomore

Junior

Senior

Course Selection *

Credit Recovery Session 1: June 6 - June 23 from 7:30 a.m. to 10:00 p.m.

Credit Recovery Session 2: June 6 - June 23 from 10:00 a.m. to 12:30 p.m.

Please list the course(s) needed for Credit Recovery. Check with your guidance counselor for help. *

Emergency Medical Information

Purpose: To enable parents and guardians to authorize the provision of emergency treatment for students who become ill or injured while under school authority, when parents or guardians cannot be reached.

Parent/Guardian 1 Full Name *

Parent/Guardian 1 Phone Number (If applicable) *

Parent/Guardian 2 Full Name

Parent/Guardian 2 Phone Number

To Grant Consent

In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) administration of any treatment deemed necessary by above-named doctor, or, in the event the designated practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any hospital reasonably accessible.
This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring with the necessity for such surgery, are obtained prior to performance of such surgery.

I hereby give consent for the following medical providers and local hospital to be called: *

Yes

Doctor *

Doctor's Phone Number *

Dentist *

Dentist's Phone Number *

Medical Specialist

Medical Specialist's Phone Number

Local Hospital *

Local Hospital's Phone Number *

Facts concerning the student’s medical history including allergies, medications being taken and physical impairments to which a physician should be alerted: *

I understand I must be in attendance for lab hours until my course(s) is/are completed. *

Yes

I understand if I fail to attend lab hours I may be dropped from my course(s). *

Yes

A copy of your responses will be emailed to the address you provided.

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