Summer School Registration

Date:

Date

FIRST NAME:

*

Middle:

LAST NAME:

*

Student DOB

*

Date

Sex

*

Male

Female

Home Address

Street Address

Street Address Line 2

City

Island

CURRENT GRADE:

*

Reading Level (FOR OFFICIAL USE ONLY)

PARENT/GUARDIAN Name:

*

First Name

Last Name

Home Phone Number

Area Code

Phone Number

Place of Employment (Mother)

Place of Employment (Father)

Work Phone Number

Area Code

Phone Number

Cell Phone Number

*

Area Code

Phone Number

Email

example@example.com

Shirt Size

Child Small

Child Medium

Child Large

Adult Small

Adult Medium

Adult Large

Does the child has any allergies? If yes , please list below

*

Yes

No

Is the child on any medication? If yes , please list the below

*

Yes

No

Has the child been diagnosed with any special condition? (academic or otherwise) If yes , please list below

*

Yes

No

Special instructions:

Name of local friend or relative (not living at same address):

First Name

Last Name

Relationship to child:

Home phone no.:

Work phone no.:

The above information is true to the best of my knowledge. I understand that I am financially responsible for any and all fees that are to be paid to the school for academic services rendered.

Parent/Guardian signature

Clear

Date

SCHOLARS’ PREPARATORY SCHOOL

STUDENT INFORMATION

MEDICAL INFORMATION

IN CASE OF EMERGENCY