CHS Summer Student Registration Form
Fill out the form carefully for registration. This form is for INITIAL credit courses for Health, PE and Econ and Personal Finance.
General Information
Students will need to attend a mandatory in-person orientation prior to starting the course if taking the course online. Summer programming will run from June 10th through July 17th. Classes will run Monday through Thursday each week. While there will be no synchronous instruction for the online courses, students are expected to login daily and complete work. Instructors will be available online between the hours of 7:45am and 1:30pm, Monday - Thursday. There will be no classes on Fridays, June 18th, June 19th and July 4th. For information regarding the mandatory virtual course orientation and other summer policies, please review the CHS Summer Program at-a-glance for more information and requirements for the courses offered.
Registration
Please note: this form should be completed by the parent/guardian, not the student. Payment will need to be received prior to being fully enrolled. Once the form is complete, the parent/guardian will receive an email with instructions for payment.
Student Full Name (first, middle, last) as entered on Birth Certificate
*
First Name
Middle Name
Last Name
Student's Preferred Name:
Birthday
*
Please select a month
January
February
March
April
May
June
July
August
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October
November
December
Month
Please select a day
1
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Day
Please select a year
2024
2023
2022
2021
2020
2019
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2015
2014
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2012
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1925
1924
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1920
Year
Assigned sex as shown on Birth Certificate
*
Please Select
Male
Female
Other
Gender Identity (optional)
Please Select
Male
Female
Non-Binary
Student Email
*
example@example.com
Student Cell Phone Number
*
Please enter a valid phone number.
The federal government requires that this question be answered and provides only the following categories for ethnic group and race. Is the student Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.) Yes or No
*
Please Select
Yes, Hispanic origin
No, not of Hispanic origin
The federal government requires that this question be answered and provides only the following categories for ethnic group and race. What is the student's race? Check all that apply.
*
Please Select
American Indian/Alaska Native
Asian
Black or African American
Native/Hawaiian/Other Pac Islander
White/Caucasian
Multiple Races
Student's Military Affiliation
Please Select
Not Military Connected
Active Duty
Reserve
National Guard: Active or Reserve
Current School Attending in 2023-2024
*
Planned School of Attendance for 2024-2025 school year
*
Current Grade level in 2023-2024
*
Please Select
8th
9th
10th
11th
Has the student ever attended a Charlottesville City School previously? If yes, enter school name please. If no, click NO.
*
Please Select
NO
Burnley-Moran ES
Clark ES
Greenbrier ES
Jackson-Via ES
Johnson ES
Walker UES
Buford MS
Charlottesville HS
Device Access
*
Please Select
1 - Provided by School
2 - Personal Device
3 - Shared Device with Family Members
4 - Smartphone Only
5 - Any Public Device
6 - No Device Access
Internet Access
*
Please Select
1 - Access at home allows for live streaming, classroom instruction, real time interactions with teachers and classmates
2 - Access at home is available but too slow for live streaming or real time interaction
3 - No internet connection available for unknown reasons
4 - No internet connection due to cost of service
5 - No internet connection due to service availability
Guardian #1 Name:
*
example@example.com
Guardian #1 Cell Phone
*
Please enter a valid phone number.
Guardian #1 Home Phone Number
Please enter a valid phone number.
Guardian #1 Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian #2 Name:
example@example.com
Guardian #2 Cell Phone
Please enter a valid phone number.
Guardian #2 Home Phone Number
Please enter a valid phone number.
Please review the At-a-Glance and Rules and Regulations carefully.
Guardian #2 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PE Courses:
Please Select
PE 09 (Virtual)
PE 10 (Virtual)
Health Courses:
Please Select
Health 09 (Virtual)
Health 10/Driver Education (Virtual)
Econ & Personal Finance Course:
Please Select
Econ and Personal Finance (11th and 12th)
Please review the CCS Acceptable Technology Use Agreement below.
By signing below I agree to the CHS Summer Academy Rules & Requirements and CCS Acceptable Technology Use Agreement outlined above.
*
Email Address of person enrolling student
*
example@example.com
Additional Comments
Submit
Current Student Status
*
Please Select
Current CCS Student
Out-of-district student attending CHS in the fall
Out-of-district student NOT attending CHS in the fall
Should be Empty: