Summer Lab Registration Form 2023

2023 Summer Lab & Summer Enrichment Registration Form
Student Information
First Name*
Last Name*
MaleFemale
Student's Current School
Grade entering in Fall 2023*
If attending Summer Lab, which area(s) of remediation would you like to see addressed for your child?
How did you hear about PHPS?
Parent/Legal Guardian 1*

Area CodePhone Number
Parent/ Legal Guardian 2

Area CodePhone Number
Address*
City*
State*
Zip*
Emergency Contact (If parent or guardian is not available)*
Emergency Contact Number*

Area CodePhone Number
Student Release
Student Release (List anyone other than parent/legal guardian to whom your student can be released)*
Tuition and Attendance Policy

Refunds cannot be made after May 1st for any reason. There are no make-up classes, nor are we able to prorate fee for partial attendance.
Summer Enrichment Classes

PLEASE NOTE: If you are registering for a Summer Lab session, check that your Summer Lab time does not conflict with the time of your Enrichment session. Enrichment classes are each two-week sessions, (M-Th). View full descriptions of enrichment options on our website. The cost for each two-week session is $300.
Session 1: Summer Enrichments: June 5- 15

*Each session lasts two weeks (M-Th)
June 5-15 8:00-9:30
June 5-15 9:30-11:00
June 5-15 11:00-12:30
Session 2 Summer Enrichments: June 19-June 29

*Each session lasts two weeks (M-Th)
June 19-June 29 8:00-9:30
June 19-June 29 9:30-11:00
June 19-June 29 11:00-12:30
Email Confirmation
Primary Email (Registration confirmation will be sent to this email address)*
Health Information

.
It is our policy to contact a student's parent(s) or guardian(s) as soon as possible in the event of injury, accident, or illness. If your child takes medication, please bring all medication in original containers. All fields below are required. If nothing applies, please put "N/A".
List any allergies, sensitivities or food intolerances (Ex: bees, peanuts, wheat, dairy, etc.)*
Payment Information

Summer Lab: $660 Summer Enrichment (each two-week session): $300
Method of Payment
Upon receipt of your full payment, PHPS will secure the session(s) you registered for. If you elected to pay via Paypal, a 3% processing fee will be assessed and you will receive an invoice by email. Refund deadline for cancelation of any summer course will be May 1st, 2023.

If you are paying by check or cash, you may bring your payment to the PHPS school office, or mail your payment (with your student's full name noted in the memo area on the check) to:

PHPS, Attn: Summer Lab/Jess Field

9800 Preston Road

Dallas, Texas 75230

Please contact Jessica Field at (214) 368-3886 or via email at Summerlab@phps.org with any questions. Thank you!
Be certain to enter your email address correctly on the registration form to receive confirmation via email.
By hitting submit and typing your initials, you agree that you are the parent or legal guardian of the above named student, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named student by authorized personnel. I understand that the above named student will only be released to the parent/legal guardian or to the names listed above. I certify that my child has permission to attend PHPS Summer Lab and/or Summer Enrichment, and can participate in all activites.
Signature*

Clear
Electronic signature, please initial*
Should be Empty:

2023 Summer Lab & Summer Enrichment Registration Form

Student Information

Student Release

Tuition and Attendance Policy

Summer Enrichment Classes

Session 1: Summer Enrichments: June 5- 15

Session 2 Summer Enrichments: June 19-June 29

Email Confirmation

Health Information

Payment Information