Wake County Public
School System
Tuition Extended High School Staff:
2007-2008 Receipt #: ___________________________
Tuition
Extended High School
Registration Form
Date: ____________________________
(Fill out one form
per course per student.)
Course:
__________________________
Tuition
Paid: _____________________
*Certified
Check or Money Order
____________________________
TEHS Staff’s Signature Date
Student: _________________________________________________________________
Last First MI Address: ________________________________________________________________
Street
City
State
ZIP
Date of Birth:
______________________
Home Phone: _______________________
Soc. Sec. #:
________________________
Emergency Phone: ___________________
NCWise#____________________________
Base School_______________________
Parent/Guardian:
_______________________ School: _______________ Class: ___________
Special Health Conditions (allergies, seizures, etc.): ___________________________________
Attendance:
Excellent attendance is required in order to receive credit for the
course.
Conduct:
Students should conduct themselves appropriately and must follow the
WCPSS
Code of Conduct.
A structured dress
code is required for all students.
Failure to follow the Dress Code will jeopardize participation in the
TEHS program. See Dress Code
Calendar:
Generally, TEHS follows the traditional school calendar.
Costs: $ 350.00 Certified check or Money Order
I have read the
information contained in this form and agree to the conditions stated above.
Full payment of courses is due at registration site.
_________________________________ ________________________________________
Parent/Guardian’s
Signature Date
Student’s
Signature
Date
NOTE: Submit
the application and money order or certified check payable to Mary E.
Phillips
High School.
_________________________ ________________________
Principal’s Signature Date Counselor’s Signature Date