You’re offline. This is a read only version of the page.
Skip to main content
Toggle navigation
Home
SRTest
Registraion
StudentRegistration
Program Information
Course/Summer Site
Clear lookup field
Launch lookup modal
Lookup records
×
Close
We're sorry, an error has occurred.
There are no records to display.
You don't have permissions to view these records.
Error completing request.
Loading...
Error
×
Close
We're sorry, an error has occurred.
Contact Information
StudentId
*
Parent or Guardian Name
*
*
Relationship (to the Student)
*
*
Address
*
*
City
*
*
State
*
*
Zip
*
*
Phone
*
*
Email
*
*
*
Confirm Email
*
*
*
Emergency Contact
Emergency Contact Name
*
*
Emergency Contact Relationship (to the Student)
*
Emergency Contact Phone
*
*
Emergency Contact Email
*
*
Confirm Emergency Contact Email
*
*
Student Health Information
Are there any health/medical issues/concerns staff should be aware of (i.e. seizures, asthma, etc)?
Are there any health/medical issues/concerns staff should be aware of (i.e. seizures, asthma, etc)?
No
Are there any health/medical issues/concerns staff should be aware of (i.e. seizures, asthma, etc)?
Yes
Medical Issues Explain
*
Does the student have any allergies (i.e. food, environmental, medical)?
Does the student have any allergies (i.e. food, environmental, medical)?
No
Does the student have any allergies (i.e. food, environmental, medical)?
Yes
Allergies Explain
*
Is the student currently taking any medication required during summer school hours?
Is the student currently taking any medication required during summer school hours?
No
Is the student currently taking any medication required during summer school hours?
Yes
Medication Explain
*
Dietary Restrictions
Dietary Restrictions
No
Dietary Restrictions
Yes
Dietary Restrictions Explain
*
Are there any other health concerns staff should be aware of?
Are there any other health concerns staff should be aware of?
No
Are there any other health concerns staff should be aware of?
Yes
Other Explain
*
Information Release Consent
Records Release Consent
Records Release Consent
No
Records Release Consent
Yes
Student Survey Release
Student Survey Release
No
Student Survey Release
Yes
Photo Consent
Photo Consent
No
Photo Consent
Yes
By clicking this box, I am signing this application and consent electronically. I certify that I am the parent or legal guardian of the student, a minor child, and the information provided here is accurate to the best of my knowledge. I hereby give permission for my child to participate in summer school activities sponsored by DCPS.
