Summer School Enrollment Form
Student Name
First Name
Middle Name
Last Name
Parent Name
First Name
Middle Name
Last Name
School Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Format: (000) 000-0000.
Parent Work Phone Number
Format: (000) 000-0000.
Parent Email
example@example.com
Grade Level
9th
10th
11th
12th
Type of Credit
Class Taken for GPA
Class Taken for Pass/Fail: (choose if top 10%)
Please Indicate Time Preference (There are no guarantees. First applications have preference in getting into class)
AM
PM
Type option 3
Type option 4
Student Signature
Parent Signature
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Form
Should be Empty: