Virtual Summer School Registration Form
Virtual Summer School Registration Form
Please complete this form to register for our Virtual Summer School.
Parent/Guardian Information
Name
Phone Number
Home Address
Preferred Contact Method
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Phone
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Email
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Text
Student Information
Student Name
Grade Level
Date of Birth
Learning Preferences/Special Needs
Course Preferences
Please select the subjects or courses your student(s) are interested in. Course availability may vary based on enrollment.
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Math Enrichment
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Science Exploration
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Reading and Literature
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Creative Writing
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Art and Design
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Coding Basics
Technology Access
To participate in virtual classes, students will need reliable internet access and a device. Please confirm your setup below:
Device Available
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Laptop
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Tablet
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Desktop
Internet Connection
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High Speed
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Moderate
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Limited
Platform Familiarity
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Zoom
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Google Classroom
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Microsoft Teams
Parent Involvement
Parental support enhances the virtual learning experience. Let us know if you’d like to assist in any capacity:
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Monitoring student progress
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Providing feedback on courses
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Organizing virtual meet-ups
Emergency Contact
Name
Relation to Student
Phone Number
Upload Supporting Files
Upload any relevant files, such as photos or documents
Additional Information
Please share any other details or questions that may help us make this summer successful for your student:
Parent/Guardian Signature
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By signing below, I consent to my student’s participation in the Virtual Summer School program and agree to adhere to the guidelines provided.
Name:
Date:
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