9-12 SUMMER SCHOOL REGISTRATION FORM
PART I – To be completed by the parent/guardian. Please print.
Student’s Last Name: _____________________________ First Name: _________________________________ Middle Initial: _____
Date of Birth:
Current School:
Current Grade:
Name of Parent/Guardian:
Parent/Guardian’s Email:
Home Phone #:
Cell #:
Address:
(Street)
(City)
Will this be your child’s address during the summer? Yes
No
(Zip)
Does your child need transportation?
Yes
No
Please list any pertinent health information: e.g. allergies, medication, etc.: _______________________________________________
Emergency Contact (other than parent/guardian listed above):
Phone #
Students will attend summer school at their zoned school, including magnet school students. Students currently enrolled at the
Performance Learning Center or RPM program will attend programs at those specific locations.
PART II – Must be completed and signed by the counselor
Please complete the following based upon the student’s needs. Reminder: The maximum offering is two courses unless the student is
attempting new work in Math to remain with their graduation cohort. In this instance, the maximum offering is one course.
Student is attending for the purpose of: ____Graduation
____Promotion
____Remain with Graduation Cohort
Traditional Remediation
Number
23.0610082
23.0620082
23.0510082
23.0520082
45.0570002
45.0610002
45.0830082
45.0830082
27.0850083
27.0990082
27.0991082
Number
27.0990082
27.0991082
Max Course Load: 2
Cost
Place ‘X’
Number
Course Name
Cost
27.0992082
Algebra II
$250
$250
60.0710082
Spanish I
$250
$250
60.0720082
Spanish II
$250
$250
60.0730082
Spanish III
$250
$250
60.0110082
French I
$250
$250
60.0120082
French II
$250
$250
60.0130082
French III
$250
$250
26.0120082
Biology I
$250
$250
40.0510083
Chemistry I
$250
$250
08.4360080
Entrepreneurship
$250
$250
$250
NEW WORK : offered only to students to remain with Cohort Graduation Group
Max Course Load: 1
Course Name
Cost
Place ‘X’
Number
Course Name
Cost
Algebra I
27.0992082
Algebra II
$500
$500
Geometry
27.0850083
Adv Math Decision $500
$500
Course Name
9th Grade Lit
10th Grade Lit
American Lit
British Lit
American Govt.
Economics
US History
World History
Adv Math Decision
Algebra I
Geometry
Place ‘X’
Place ‘X’
RCSS Virtual School* (Edgenuity)
Number
23.0610086
23.0620086
23.0510086
23.0520086
45.061006
45.0810086
45.0830086
27.0990086
27.0991086
Course Name
9th Grade Lit
10th Grade Lit
American Lit
British Lit
Economics
US History
World History
Algebra I
Geometry
Cost
$250
$250
$250
$250
$250
$250
$250
$250
$250
Max Course Load: 2
Place ‘X’
Number
27.0992086
27.0850086
26.0120086
40.0510086
40.0110086
40.0810086
17.0110006
50.0211086
Course Name
Algebra II
Adv Math Decison
Biology I
Chemistry I
Physical Science
Physics
Health
Visual Arts
Cost
$250
$250
$250
$250
$250
$250
$250
$250
Place ‘X’
Summer School Offerings: Other
*Must be approved by the administrator or counselor
Course Name
Cost
Approved By
(administrator or counselor signature)
$250
$250
Number
Total Tuition Due: $ ________ or Title I Tuition Waiver
Money orders or cashier’s checks should be payable to Richmond County Board of Education and paid at the home school.
NOTE: Tuition waivers are designated to Title I middle and high schools for Math, Science, Social Studies, and English courses only.
Counselor’s Signature: _______________________________________________
Date: _____________________________
Parent’s Signature: __________________________________________________
Date: _____________________________
Entered into Infinite Campus
Initial: