Summer School Registration

Required

Student Namerequired

First Name

Last Name

Date of Birthrequired

Must contain a date in M/D/YYYY format

School Student Currently Attendsrequired

Other School

2023-2024 Grade Levelrequired

Parent/Caregiver Namerequired

First Name

Last Name

Street Address

City (if not Medford)

State

Zip code

Parent/Caregiver Phone Numberrequired

Parent/Caregiver's Email Address

Additional Phone Number(s) in Case Parent/Caregiver Can Not Be Reached

Course Selection (8:00 - 10:00 a.m.)

Course Selection (10:05 a.m. - 12 p.m.)

Medical Treatment

I know that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I can’t be reached, I authorize program staff to call 911 to arrange for transport to the nearest hospital or medical facility and to secure necessary treatment.

Signature of Parent/Guardianrequired

Daterequired

Enrollmentrequired

MPS student: one course ($250.00)

MPS student: two courses ($500.00)

Non-MPS student: one course ($300.00)

Non-MPS student: two courses ($600.00)

Payment Information

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Please select a payment typerequired

Credit Card

Billing Addressrequired

Address

City

State/Province

Country

Zip/Postal Code

Cardholder Namerequired

First

Last

Card Numberrequired

Expirationrequired

CVV Numberrequired

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Summer School Registration

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