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BOARD OF COOPERATIVE EDUCATIONAL SERVICES 2010-11 Summer School Regents/RCT Registration
DIRECTIONS: Your home school principal or guidance counselor must approve your registration by signing this registration form. If you are taking The Earth Science Regents, underastand that you MUST re-take the lab portion prior to the Regents even if you have already passed this portion. You will be notified by hte personnel at your registration site as to the date and time of the lab portion.
THE ATTACHED MEDICAL FORM MUST BE COMPLETED AND SUBMITTED WITH REGISTRATION.

PLEASE DO NOT FORGET TO COMPLETE AND ATTACH THE MEDICAL INFORMATION FORM TO THE REGISTRATION FORM WHEN SUBMITTED. A LINK FOR THE MEDICAL INFORMATION FORM CAN BE FOUND ON THE REGISTRATION COMPLETION PAGE.

Any fields noted with a *  are required. All data collected in this form will be handled according to the guidelines set forth in our privacy policy.
*  Student Name
  Last Name:
  First Name:
Email:
 
*  Mailing Address
  Street:
  Apartment Number:
  City:
  State:
  Zip:
*  Date of Birth:
(ex: mm/dd/yy)
*  Sex: M F
*  Social Security Number:
(ex: 111-22-3333)
*  09-10 Grade in School:
*  Home School Name:
*  School District Residency:
*  Name of Parent/Guardian:
*  Home Phone:
(ex: 111-222-3333)
*  Emergency Phone:
(ex: 111-222-3333)
Special Education Yes No
IEP MUST BE ATTACHED		  
STATE EDUCATION EXAMINATION REQUEST
Check RCT(s) needed:
Math RCT: Science RCT: Global RCT: US History RCT: Reading RCT: Writing RCT:
Check Regents Exam(s) needed:
Earth Science:                 Living Environment: Chemistry: Comp. English:
Geometry: Algebra 2/Trigonometry: Intergrated Algebra: Global History:
U.S. History:      

PRINCIPAL'S APPROVAL

I approve of the above summer school registration. All state required immunizations have been received.

 
Principal's or Guidance Counselor's Name
Home School Phone Number
(ex: 111-222-3333)
Date
(ex: mm/dd/yy)
 
PARENTAL CONSENT 
Payment must be made by money order or bank check
payable to the district where the student registers.

Cash and personal checks will not be accepted

If your child does not take the exam for which they are scheduled, no refund will be given.

You agree that your child will follow the summer school site's Code of Conduct regarding discipline and attendance.

If you are a NON-DISTRICT RESIDENT or a STUDENT FROM A NON-PARTICIPATING DISTRICT, the student is to
pay the amount listed for each district, per course, Central Islip - $37.54; East Islip - $42.35; Patchogue-Medford $45.16; Riverhead $49.93.
 
Non-Discrimination Statement
The Eastern Suffolk BOCES does not discriminate against any employee, student, applicant for employment or candidate for enrollment on the basis of gender, race, color, religion or creed, age, national origin, marital status, disability or any other classification protected by law. For further information or concerns regarding this statement, please contact the Eastern Suffolk BOCES Department of Human Resources at (631) 687-3029.
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