Summer School Registration Form
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Student Name
Student Date of Birth
MM
/
DD
/
YYYY
Age
Sex
Clear selection
Known Medical Concerns
Medications
School for 2020-2021 School Year
Grade for 2020-2021 School Year
Clear selection
Address of Student
Student Email Address
Parent/Guardian Name
Parent/Guardian Home Phone
Parent/Guardian Work Phone
Parent/Guardian Cell Phone
Emergency Contact Name
Emergency Contact Phone
Relationship to Student
Insurance Carrier *
Policy Number *
Address and Phone Number of Insurance Carrier *
The school has my permission to take my child to the nearest hospital in an emergency. The medical staff of the hospital has my consent to provide treatment for my child. In addition, I have read and agree to the policies outlined surrounding Summer School attendance and behavior. *
Signature of Parent/Guardian Agreeing to Treatment *
Summer School Logistics
Name of Term 1 AM Course (indicate which semester or if this is a full term course)
Is this an ACCESS course? ACCESS is an online learning experience managed by the Alabama State Department of Education in conjunction with local schools. ACCESS classes may be entirely online or be conducted via teleconferencing. All test/assessments must be completed in the presence of a school facilitator.
Clear selection
Is this for credit recovery or initial credit/credit advancement? Credit Recovery is defined as the need for a student to repeat a course to complete the requirements to obtain credit for that course. Eligibility depends upon the student’s failing grade in their original course. Students with grades lower than a 40 are not eligible for credit recovery, instead must repeat the entire course.
Clear selection
Name of Term 1 PM course (indicate which semester or if this is a full term course)
Is this an ACCESS course? ACCESS is an online learning experience managed by the Alabama State Department of Education in conjunction with local schools. ACCESS classes may be entirely online or be conducted via teleconferencing. All test/assessments must be completed in the presence of a school facilitator.
Clear selection
Is this for credit recovery or initial credit/credit advancement? Credit Recovery is defined as the need for a student to repeat a course to complete the requirements to obtain credit for that course. Eligibility depends upon the student’s failing grade in their original course. Students with grades lower than a 40 are not eligible for credit recovery, instead must repeat the entire course.
Clear selection
Attendance Policy
Behavioral Expectations
By submitting this form, you/your child agree to abide by the policies established in this form. *
Submit
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