Pleasant Hill R-III School District Summer School
Due Friday April 30th
Pre-K thru 6th Registration Form
For Office Use Only
Birth Date _____________________
Grade level for 2009-2010
Address _____________________________City __________________
Home Phone _____________________Work Phone
Emergency Contact Person
Will your student need bus transportation? (circle one)
List the classes for which you wish to register. List in order your top 4 choices.
Every effort will be made to place students in their top 2 choices.
Please remember class availability is subject to student enrollment.
1) Course Name
2) Course Name
3) Course Name
4) Course Name ____________________________________________
I have read the summer school information. I agree to follow all Pleasant Hill R-3 policies and procedures. I further understand that I will be asked to leave Summer School if I choose not to follow these policies and procedures.
PLEASE RETURN TO YOUR CHILD’S SCHOOL OR TO PLEASANT HILL MIDDLE SCHOOL ATTENTION: KAREN TARPENNING 1301 MYRTLE
For Office Use Only SIS enrollment
PLEASANT HILL, MO 64080.
Fax 816-987-2017 TH BY FRIDAY, APRIL 30