Very Important!

Student Name *

First Name

Last Name

Current Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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HGU Student Contract *

Haysville GEAR UP is committed to your child’s academic success. The program will be offering the following opportunities for your child to thrive as a high school student for Fall 2021. - Credit Recovery fees/cost – Summer 2021!! - Summer program – NO COST! - Summer Dates – June 7th – July 1st from 11:30 AM to 2:00 PM - Staying on track with your graduating class - STEM, College and Career Exploration activities. HGU has partnered with Haysville Public Schools to make this opportunity possible. Space is limited and students will need to be fully registered to guarantee a spot. By signing up students and parents agree to the following terms and conditions: - Arriving on time Monday through Thursday from 11:30 am to 2:00 pm - Students must attend a minimum of 12 days - Student Behavior - Be an active listener and participate. - Be respectful to all staff and students, at all times. - Technology stays in backpacks while class is in session (unless it is being used as part of the curriculum or for an activity Failure to adhere to this contract or complete the program will result in forfeit of any potential credit payments and fees. PLEASE SELECT ONLY ONE OF THE CHOICES BELOW:

I agree to the terms listed above (Digital Signature)

I will return the paper copy of the contract before the start of Leg Up with GEAR UP (Print Paper Copy Below)

Student Digital Signature

Please enter student name if signing digitally

First Name

Last Name

Parent/ Guardian Digital Signature

Please enter parent/guardian name if signing digitally

First Name

Last Name

Campus Credit Recovery Registration *

Yes I have completed the registration process through Campus High School

No I have not completed all 12 pages of registration through Campus High School