Paint Branch High School Summer Programs 2015- Registration Form
Which program are you registering for?
Dates (circle one where needed)
Freshman 101
July 6 – July 9
or July 20 – July 23
AP Skills Enrichment
June 22- June 25 or July 6- July 9
PBSS 2.0 – Paint Branch Summer School 2.0 (session A)
June 22 – July 9
PBSS 2.0 – Paint Branch Summer School 2.0 (session B)
July 13 – July 30
Student School Email (required): ___________________________________________________________
Parent Email (required): __________________________________________________________________
Address: _______________________________________________________________________________
Street
City
State
Zip
Does the student have one of the following:
IEP
504 Plan
Registration opens March 16th for session A & B classes, and closes when each class fills. Submit
forms, form of payment, and waiver documentation to Ms. Crump in room 2221
PART III: PAYMENT—Attach check or money order for the REQUIRED TUITION amount.
• Student may qualify for reduced tuition. To apply, attach MCPS form 325-4: Application for Partial or Full Waiver of Summer School
Tuition and supporting documents.
Method of Payment – please make one check/money order per class, put student’s full name and class in memo
Cash $
Amount $________
Check #__________
Amount $________
Make payable to Paint Branch High School
Money Order #__________
Amount $________
Make payable to Paint Branch High School
Registration is not complete until payment is made.
PART IV: Parent’s/Guardian’s Signature: ______________________________________
Parents/Guardian’s signature certifies that:
•
•
Student has met all immunization requirements.
•
The parent/guardian will provide the summer school site administrator with a copy of the accommodations included on the student’s
IEP/504 plan
•
•
Attendance is a requirement for continued enrollment in PBSS 2.0.
Method of payment is assured and it is understood that a $25.00 fee will be assessed for returned checks. In addition, it is
understood that failure to make payment will result in dropped registration.
Students must have access to the internet, be committed to doing 3-5 hours of online class work on non-class days, and 2-3 hours of
homework after each class session.
• Students and parents must sign the attached contract indicating their agreement and understanding of these
requirements.