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Fill and Sign the Insurance Invoice Template Form

Fill and Sign the Insurance Invoice Template Form

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DCPS Summer School Enrollment Form High School Application for Summer School 2011 STUDENT INFORMATION Name: Gender: M F Address: Preferred Language: Student ID: Phone: Email: 2010-11 Grade: Best way to contact: Phone /Email 2010-11 Home School: Date of Birth: CONTACT INFORMATION Parent/Guardian Name: Relationship: Address: Phone: Email: Emergency Contact Name: Relationship: Address: Phone: Email: RELEASE INFORMATION – I agree to the following terms: I hereby give permission for my child to participate in summer school activities sponsored by DCPS. I understand that all students are expected to have perfect daily attendance and punctuality. Three (3) unexcused absences will cause a student to be dismissed from the Summer School Program. Three (3) unexcused tardy arrivals will be counted as one (1) unexcused absence. Parents/Guardian Signature: Date: For School Use Only Eligibility Verified SYEP Registration Receiving Special Education English Language Learner Residency Verified Counselor: Courses Requested Course 1: Course 2: Course 3: Date: 1 2 00 Fi rs t St r eet , NE | W as h in g t on , D C 2 0 0 0 2 | T 2 0 2. 4 4 2. 5 8 8 5 | F 2 0 2. 4 4 2 . 50 2 6 | ww w. dc ps . dc . g o v

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