EmailMe Form - BCS 2022 Summer School Application

Student's Name *

First Last

Student's Birmingham City Email *

Please enter your BCS email address (@bhm.k12.al.us).

Current BCS School *

Grade
Please enter the student's current grade for the 2021-2022 school year. *

Summer Program Choice
Please check only one box. Refer to booklet for more information. *

District Program (My child will attend promotion/enrichment at the BCS hub school.) (See pages 3-6)

School Program (My child will attend enrichment at their home school.) (See pages 7-18)

Partner Program (My child will attend the BCS partner enrichment program.) (See pages 19-21)

Will your child need after-school care? (1:00pm-6:00pm) *

Yes

No

My child has an IEP plan

My child has an ESL plan

My child has a 504 plan

Parent's Name *

First Last

Parent's Phone *

### - ### - ####

Parent's Email *

Student's Current Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Emergency Contact Name *

First Last

Emergency Contact Phone *

### - ### - ####

Emergency Contact Relationship

Parent

Guardian

Other

Will your child need transportation? *

Yes

No