Northshore School District
Secondary Summer Academy Registration Form

After completing this form, you will be directed to submit payment.  You may need to re-enter some of the information such as student name and address.If you experience any difficulty registering for Secondary Summer Academy, contact the program registrar at 425.408.6011 or ssummerschool@nsd.org.


Items denoted with a red asterisk * are required.
 * Full Name
 
First Name
M.
Last Name
 * Address
 
Address 1
Address 2
City
State
Zip Code
 * Birthdate
 

month/day/year
 * Current Grade Completed
 
 * Parent/Guardian Name
 
First Name
M.
Last Name
 * Parent Home Phone
 
 -  - 
(XXX)-XXX-XXXX
 * Parent Work Phone
 
 -  - 
(XXX)-XXX-XXXX
 * Parent Email Address
 
 * Emergency Contact #1 Name
 
First Name
M.
Last Name
 * Emergency Contact #1 Phone
 
 -  - 
(XXX)-XXX-XXXX
 * Emergency Contact #2 Name
 
First Name
M.
Last Name
 * Emergency Contact #2 Phone
 
 -  - 
(XXX)-XXX-XXXX
 * Physician's Name
 
First Name
M.
Last Name
 * Physician's Phone Number
 
 -  - 
(XXX)-XXX-XXXX
School Student Recently Attended
 
School Student Will Attend in Fall
 
Student ID Number
 
Is this student in Special Education?
 
Is a '504' in place?
 
Does your child have a life-threatening condition?
 
Describe any health problems or special needs, including allergies.
 
Vehicle License #
 
Car type/model
 
General Campus Regulations
 

1. Secondary Summer Academy is a closed campus school. Once students arrive on campus, they cannot leave during breaks. Visitors must check in at the school’s main office.
2. Students may not disrupt other classes or endanger people or school property.
3. Students shall wear clothing that is appropriate and preserves modesty, not bare midriff or underwear showing. Clothing with print or pictures that involve drugs, tobacco, sex or improper language will not be permitted. All students shall wear shoes.
4. Inappropriate, rude or disrespectful language is unacceptable.
5. All students will be in a classroom during class time. No Loitering is permitted in the halls, parking lots or other parts of the school premises. Personal business must be conducted outside of school time.
6. If a student is caught cheating on a class assignment or exam, the student will receiving a failing grade for that assignment or exam. Make-up or retake is not permitted. A student caught helping another student cheat will be docked points, to be determined by the teacher, for the final score for the lesson.
7. Student drivers who race, “squeal,” speed or operate a motor vehicle in a reckless manner on school property or park in an unauthorized area will lose the privilege of bring their vehicle on campus.
8. Audio systems (e.g. but not limited to headphones, iPods, cell phones, pagers, etc.) are not allowed during class time.
9. Students are allowed to bring plain water in appropriate containers into the classroom. All food or drink (other than water) must be consumed outside of class time. Trash must be placed in the appropriate containers. Please recycle. Classrooms and the campus must be maintained in good condition.
10. In addition to the campus regulations listed above, students are expected to comply with the teachers’ class rules and the Northshore Handbook of Rights and Responsibilities.
11. Student discipline involving “exceptional ,misconduct” as listed in the Northshore Handbook of Rights and Responsibilities will be cause for removal without credit or refund of tuition.
 * I read and agree to the Policies and Regulations listed for Secondary Summer Academy.
 
First Name
M.
Last Name