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KHS Summer 2018 Registration Form
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* Indicates required question
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
Student's Middle Name
Your answer
Student's Email
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Parent/Guardian Name
*
Adult 1st Contact.
Your answer
Relationship to Student
*
Your answer
Parent/Guardian Email (Information will be sent to this email)
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Secondary Contact Person
Your answer
Relationship of Secondary Contact to Student
Your answer
Secondary Contact Email
Your answer
Secondary Contact Phone Number
Your answer
School Currently Attending
*
Your answer
Current Grade
*
Your answer
School Attending in the 2018-2019 School Year
*
If unsure, enter name of school most likely to attend.
Your answer
Age
*
Your answer
Received Special Education Services During the School Year
*
Yes
No
Course # (from Course List)
*
Your answer
Course Name
*
Your answer
Preference
*
Online
Traditional
For Credit Recovery or Credit Accrual?
*
Credit Recovery. I took this course before but did not earn the credit.
Credit Accrual. I have not taken this course before.
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