Thomas Edison High School. Portland, Oregon.

Summer Classes Registration

Registration

To enroll your child, fill out and submit this form today. Students will be enrolled in the order in which their application with full payment is received.

Tuition is due in full by June 1st. Until June 1st, tuition is refundable less 50%. Tuition is non-refundable after June 1st. Financial adjustments cannot be made for absences or withdrawal after the session begins.

Payment plans and limited scholarships are available.

Upon enrollment, a confirmation card will be mailed. A student handbook and additional summer school information will be sent just before the session begins.

Courses with fewer than six students will be offered at the discretion of the Summer Program Director. Notifications and refunds due to cancellation will be given by June 30th.

Registration

Student Information All student fields must be filled in.

First Name:

Last Name:

Date of birth (MM/DD/YYYY):

Gender:

	Male
	Female

Grade
(as of last fall):

School:

Nature of
learning
difference:

Does student
have IEP?

	Yes
	No

Address:

City:

State:

Zip:

Parental Information The name, daytime phone and email address of either the child's mother or father are required.

Parent Name:

2nd Parent Name:

Is 2nd parent spouse?

YES

Parent Home
Phone:

2nd Parent Home
Phone:

Parent Cell
Phone:

2nd Parent Cell
Phone:

Parent Work
Phone:

2nd Parent Work
Phone:

Parent Email:

2nd Parent Email:

Parent Address:

2nd Parent Address:

Emergency Name:

Emergency Phone:

Permission

I give permission to the summer school program to exchange information with my child’s school regarding academic and behavioral progress.

Enrollment Information Please check 2 of the following 3 classes.

	Reading
	Writing
	Math

(Learning strategies included in each class.)

Note: Your child is reserved space only after payment is received. See below.

Payment Information

2008 Session Fee: $810.00
Registration Fee: $100.00 (applied to tuition)

Please send Payment to:
Middle School Summer Program
Thomas A. Edison High School
9020 SW Beaverton Hillsdale Hwy
Portland, OR 97225

Please make check payable to:
TAE Summer Program