2023 Online Health Registration Form

SJCA Online Health Registration Form

Summer 2024
Student Full Name*

First NameLast Name
Student Email
example@example.com
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Phone

Area CodePhone Number
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email
example@example.com
Parent Cell Phone

Area CodePhone Number
My student is requesting ONLINE SUMMER HEALTH. Check one box below for the course replacement that will fill the open spot in your student's Freshmen schedule.

Art FoundationsMusic FoundationsIntro to BusinessHigh School Engineering
I understand that in order to participate in the SJCA Summer Online Heath Class, my student must be registered for the 23-24 school year?

Yes
By signing this form, I understand that my child,listed above, is registering for the ONLINE Summer Health Course.

By signing this form I understand that this course is designed for independent learning. Students with academic challenges will not receive support from the Learning Resource Center during the summer.

By signing this form I understand that I will not receive a refund for this course for any reason. However, my child may drop this course by Monday, July 11th, and will be enrolled in the Fall 2023 or Spring 2024 semester with no credit for work already completed.

Payment must be received before a student will be enrolled in this course.
Parent Signature

Clear
Parent Printed Name*
Payment Method
If you select submit check to the main office, please write checks out to SJCA. You will not be able to fill out any information in the payment section when chosing this option.

PAYMENT INFORMATION
My Products*
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SJCA Summer Online Heath$225.00

Total $0.00

Should be Empty:

SJCA Online Health Registration Form