2015 MIDDLE SCHOOL SUMMER SCHOOL REGISTRATION FORM
Patrick Henry High School
June 22 - August 5, 2015 -- 7:30am-1:00pm
STUDENT INFORMATION
Student Name:
Home School:
Date of Birth:
Student ID #:
Parent Name:
Grade:
Email:
Home Address:
Parent Phone:
Parent Phone (alt):
Emergency Contact:
Please check one:
E. C. Phone #:
Hanover County Resident 
Non-Resident 
I have read and understand the regulations on attendance, student conduct, and student dress stated in the brochure I
received when I enrolled in summer school. I agree to abide by all rules and expectations for student behavior as outlined in
the Hanover County Code of Student Conduct.
(Signature of Parent)
(Signature of Student)
(Date Signed)
FORM DUE DATE
Registration begins May 4, 2015. Completed forms should be returned to student’s school counselor by JUNE 12, 2015, or if
submitting after June 12th, registrations should go to the school counselor at Liberty Middle School by JUNE 16. Registrations
will not be accepted after June 16, 2015.
COURSE INFORMATION
Sufficient enrollment will determine if a course will be available. Classes are held Monday through Thursday at Patrick Henry
High School, 7:30am-1:00pm, unless otherwise noted. July 2nd is a holiday; no classes will be held that day.
TUITION
 Hanover County Resident - $170 per course; Non-Hanover County Resident - $255 per course
 Students are allowed to take up to two (2) courses during summer school (June 22 - August 5, 2015).
 If a student does not pass an SOL test, tuition is not charged for the corresponding academic course. If a second
course is taken, tuition must be charged for the second course only.
ACADEMIC COURSES: To enroll, place an “N” on the line next to the course that you will be taking as a NEW course. If you
are repeating the class, place an “R” on the line.
SESSION I: Language Arts
June 22 - July 14, 2015
E100: Language Arts 6
E105: Language Arts 7
E110: Language Arts 8
SESSION II: Mathematics
July 15 - August 5, 2015
M200: Math 6
M203: Math 7
M208: Math 8
Science and Social Studies
(scheduled based on enrollment)
S301: Life Science
S303: Physical Science
S351: Earth Science
H400: U.S. History I (6)
H401: U.S. History II (7)
H402: Civics (8)
COURSE INFORMATION, continued
ENRICHMENT COURSES: Dates, times, and costs differ for the Enrichment courses; see below for details of each. Classes will
be held Monday through Thursday only. To enroll, check the box next to the course that you would like to attend. If there
are two sessions being offered for a course, please specify between Session I and II by checking the appropriate box. Course
credit is not given for Enrichment courses.
 Artrageous! Ceramics (SU33)
July 20-30, 2015; 8:00am - 12:30pm
$175, Hanover County residents; $225 non-residents
Enrollment: minimum 12; maximum 16
 Artrageous! Game Design (SU40)
June 22 - July 1, 2015; 8:00am - 12:30pm
$175, Hanover County residents; $225 non-residents
Enrollment: minimum 12; maximum 16
 Artrageous! Printmaking (SU34)
July 20-30, 2015; 8:00am - 12:30pm
$175, Hanover County residents; $225 non-residents
Enrollment: minimum 12; maximum 16
 Artrageous! Surface Design (SU35)
June 22 - July 1, 2015; 8:00am - 12:30pm
$175, Hanover County residents; $225 non-residents
Enrollment: minimum 12; maximum 16
 Bridges to Algebra (EL50)
 Session I: June 30, July 1-2 and July 7-9, 2015
 Session II: July 14-16 and July 21-23, 2015
7:30am - 1:00pm
$125, Hanover County residents only
 ESL Tutorial (SU01)
June 22 - July 23, 2015; 7:30am - 1:00pm
No charge; Hanover County residents only
 Keyboarding (SU36)
 Session I: July 6-8 and 13-15, 2015
 Session II: July 27-29 and August 3-5, 2015
8:00am - 12:00pm
$75, Hanover County residents only
Enrollment: minimum 10
 “Middle School Jump Start” - Organization &
Study Skills for 6th Graders (SU37)
July 6-9, 2015; 8:00am - 12:00pm
$65, Hanover County residents only
Enrollment: rising 6 th graders only
 STEM Engineering Camp (SU41)
August 10-13, 2015 - Choose one of the sessions below:
 Session I: 9:00am - 12:00pm
 Session II: 1:00pm - 4:00pm
$60, Hanover County residents only
Enrollment: rising 7 th-8th graders only
 STEM+H - Health Science Camp (SU42)
August 3-6, 2015 - Choose one of the sessions below:
 Session I: 9:00am - 12:00pm
 Session II: 1:00pm - 4:00pm
$60, Hanover County residents only
Enrollment: rising 7 th-8th graders only
NOTE: Both STEM courses will be held at the Hanover County Specialty Center at Hanover HS; see brochure for more details.
--- SCHOOL USE ONLY: Payment Details & SOL Information --Amount Due:
$
Paid by:
Payment Received By:
 Check
#
OR
 Cash
Date Received:
SOL INFORMATION: Only for the course(s) for which the student has registered, please indicate below if he/she passed the
corresponding SOL. COUNSELOR: Circle below SOL to be tagged for free tuition, if applicable. (maximum: 1 course)
Course
E100: Language Arts 6
E105: Language Arts 7
E110: Language Arts 8
M200: Math 6
M203: Math 7
M208: Math 8
Passed SOL Test?
YES
NO
Student has an IEP^:
Course
S301: Life Science
S303: Physical Science
S351: Earth Science
H400: U.S. History I (6)
H401: U.S. History II (7)
H402: Civics (8)
^If “yes,” attach profile sheet.
The School Counselor signature is required for enrollment in summer school 2015.
(Signature of School Counselor)
(Date Signed)
Passed SOL Test?
YES
NO
n/a
n/a
n/a
n/a