Summer School Registration Form - Fremont Unified School District

FREMONT UNIFIED SCHOOL DISTRICT
2012 HIGH SCHOOL SUMMER SCHOOL STUDENT REGISTRATION FORM
Location, calendar, bell schedule and other information is provided on a separate sheet. Please save that sheet for your records.
Students can take courses to improve D or F grades only; course advancement is not permitted.
Please see other side for course schedule and course selection.
RETURN TO COUNSELOR BY FRIDAY, APRIL 20, 2012
PLEASE PRINT CLEARLY Current School:___________________________
Student Name: ___________________________________________ Student ID #: _____________ Present Grade:________
Last First M.I.
Birthdate: ______________ Sex: M F Home Phone: ________________________________
Address:_______________________________________________________________________________________________
No. Street City State Zip
Parent/Guardian: ____________________________________________ Work/Cell Phone ( )_________________________
Parent/Guardian: ____________________________________________ Work/Cell Phone ( )_________________________
Additional Emergency Contact: ________________________________ Work/Cell Phone ( )_________________________
Please list any health problems: i.e.; diabetes, asthma, bee stings, etc.: __________________________________________
If your child is on medication: (Please give specific directions.): __________________________________________________
______________________________________________________________________________________________________
(Does your child receive specialized physical health care services at school: (What are the current physician orders?)
IF THE STUDENT REQUIRES ADMINISTRATION OF MEDICATION WHILE ATTENDING SUMMER
SCHOOL, A MEDICATIONS AT SCHOOL FORM MUST BE ATTACHED. IF ONE IS CURRENTLY ON FILE AT
SCHOOL PLEASE ATTACH A COPY. ANY NEW MEDICATIONS REQUIRE A NEW FORM.
PLEASE REFER TO THE OTHER SIDE OF THIS FORM FOR COURSE SELECTION.
All classes meet for 2 hours and 30 minutes: Period 1: 7:30 AM –10:00 AM Period 2: 10:20 AM – 12:50 PM
I hereby authorize medical services for my son/daughter and understand I will be responsible for fees. Also I
acknowledge that health information may be shared with FUSD staff as needed.
Parent/Guardian must notify school within five (5) school days of any new address or telephone number. If you do not
notify the school, this is falsification of information (BP5111) and will result in immediate disenrollment.
THIS FORM MUST BE SIGNED BY BOTH STUDENT AND PARENT BEFORE IT IS SUBMITTED TO THE
COUNSELOR BY FRIDAY, APRIL 20, 2012 on a first-come, first serve basis.
Student Signature: _______________________________________________________ Date: _________________________
Parent Signature: ________________________________________________________ Date: _________________________
District Use Only Counselor must complete:
A COPY OF THE STUDENT’S FALL SEMESTER TRANSCRIPT MUST BE ATTACHED.
504 Plan: Yes _______ No _______ (If yes, please attach copy.)
RSP: Yes ________ No _______ (If yes, please attach copy of IEP accommodations, only, not full IEP.)
FAILED CAHSEE : ________MATH ________LANGUAGE ARTS
Counselor Comments:____________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
________________________________________________________________
Counselor Signature Date

FREMONT UNIFIED SCHOOL DISTRICT
2012 HIGH SCHOOL SUMMER SCHOOL STUDENT REGISTRATION FORM
ID#:_____________________________
Depending on the availability, students may select up to two summer school classes and one alternate should the one or
two classes chosen become unavailable or full. Students should talk with their counselor or administrator for course
recommendations and help with registering. Registration is on a first-come, first serve basis.
Course selection(s): In the line provided, indicate the choices by writing the following by the side of the selected class:
1. “1” = First choice for class
2. “2” = Second choice for class if a second class is available
3. “A” = Alternate if the first or optional second class is not available.
CODE TITLE CODE TITLE
___ EZCPF English 9 – Semester 1 ___ MGFPF Geometry - Semester 1
___ EZCPS English 9 – Semester 2 ___ MGFPS Geometry - Semester 2
___ EZFPF English 10 – Semester 1 ___ MAIPF Algebra 2/Trigonometry Semester 1
___ EZFPS English 10 – Semester 2 ___ MAIPS Algebra 2/Trigonometry Semester 2
___ EZIPF English 11 – Semester 1 ___ MBIGF Business Math – Semester 1
___ EZIPS English 11 – Semester 2 ___ MBIGS Business Math – Semester 2
___ EZLPF English 12 – Semester 1 ___ PZFGF Physical Education – Semester 1
___ EZLPS English 12 – Semester 2 ___ PZFGS Physical Education – Semester 2
___ GSCPF Spanish 1 – Semester 1 ___ QBFPF Biology – Semester 1
___ GSCPS Spanish 1 – Semester 2 ___ QBFPS Biology - Semester 2
___ GSFPF Spanish 2 – Semester 1 ___ QCIPF Chemistry – Semester 1
___ GSFPS Spanish 2 – Semester 2 ___ QCIPS Chemistry – Semester 2
___ HZAG Health ___ QICPF Integrated Science 1 – Semester 1
___ MCCPF Algebra 1 – Semester ___ QICPS Integrated Science 1 – Semester 2
___ MCCPS Algebra 1 – Semester ___ SWFPF World History - Semester 1
___ MIIPF Int. Algebra – Semester ___ SWFPS World History – Semester 2
___ MIIPS Int. Algebra – Semester 2 ___ SGJP Amer. Government
___ MGFGF Discovering Geometry – Sem. 1 ___ SGKP Economics
___ MGFGS Discovering Geometry – Sem. 2
___ SHIPF U.S. History - Semester 2
___ SHIPS U.S. History – Semester 1
ELECTIVE COURSES
CODE TITLE CREDITS
___ YDFG Driver Education 2.5
___ FJFP Film in the 20th Century 5
___ COAG Computer Operations 5
___ EECG English Language Development - Level 1 5
___ EEFG English Language Development - Level 2 5
___ EZBRF Read to Achieve – ELD Level 3 5
___ YZAR CAHSEE English Prep 5
___ YMAR CAHSEE Math Prep 5
All classes meet for 2 hours and 30 minutes. Period 1: 7:30 AM –10:00 AM Period 2: 10:20 AM – 12:50 PM