MBAF MCHS Summer School Application Form

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2008 Mira Costa High School Summer School Program
Academic Classes June 24 through August 1; Athletic Classes, June 24 through July 25; (no school July 4)
First Period Classes: 8:00—10:10; Second Period Classes: 10:25—12:35.

Application Form

• Registration
• Emergency
• Permission
• Class Selection

© 2008 by MBAF
Manhattan Beach
Athletic Foundation
PO Box 1585
Manhattan Beach CA
90267-1585
E-mail (preferred):
Eileen@wvcpas.com
Tel: 310.415.5827

MBAF TAX ID:
#02-0603467

Note: If you wish to apply by mail rather than use the on-line application below, then request application materials from the Manhattan Beach Athletic Foundation, PO Box 1585, Manhattan Beach CA 90267-1585. You must mail the completed registration information and tuition, postmarked no later than May 31, 2008. Checks will be accepted with mail-inapplication. No confirmation will be made over the phone.

You MUST fill out this application in order to register for a class.
After completing the form, click on "Submit Application".
A web page will then automatically appear which will allow you to pay for a class (or classes).
If you encounter problems, email us at Eileen@wvcpas.com.

(Fields with * MUST be filled in!)

Student's Legal Name (last, first, middle)* :

Student's Preferred Name:

Sex* : Date of birth (mm/dd/yy)* :

Street Address* :

City* :State* : Zip* :

Student Home Phone* : Student Cell Phone:

Student E-mail:

Grade Entering Fall 2008* : School Attending Fall 2008*:

Have you previously attended Mira Costa High School?*
Parent or Guardian (Dr./Mr./Mrs./Ms.)* :

Mother/Guardian*: Daytime Phone: Cell/Page:

Employer Contact:

Father/Guardian*: Daytime Phone: Cell/Page:

Employer Contact:

Is there any medication student MUST take during school hours?

Are there current health problems or allergies to drugs or foods (specify)?

In the event of illness or injury during school hours, contact*:

Where can the student’s parents or guardian be contacted during school hours? If employed during school hours, please provide all pertinent information; employer, telephone numbers including cell and pager, department supervisor, etc.

In the event I cannot be reached, permission is hereby given for the physician or hospital designated below to provide emergency care for my child should serious illness/injury occur during school hours. I also authorize the principal or his/her designee (acting in representation for Mira Cost High School) to offer consent to medical attention by calling 911 and/or to offer consent as needed.

Physician Name, Address, Phone*:

Hospital Name, Address, Phone*:

Emergency information submitted by*:

E-mail Address*: Date (mm/dd/yy)*:

We have read and discussed the Student Code of Conduct (on "start" web page) and accept the values and standards set forth. It is understood that inappropriate behavior that disrupts classroom learning or prevents others from enjoying an outing, is grounds for dismissal from the program.

My child has my permission to participate in walking field trips. I understand teachers will indicate in their newsletters where and when such trips will take place.

You may choose one Period 1 and one Period 2

Semester Review Class, Period 1

Semester Review Class, Period 1

Semester Review Class, Period 2

Semester Review Class, Period 2

TUITION: Each one semester course: $250.00 ($225.00 if registered BEFORE June 1st.)

You may choose one Period 1 and one Period 2

Semester Original Credit Class, Period 1

Semester Original Credit Class, Period 1

Semester Original Credit Class, Period 2

Semester Original Credit Class, Period 2

TUITION: Each one semester course: $250.00 ($225.00 if registered BEFORE June 1st.)

Yearlong Original Credit Class

Yearlong Original Credit Class

TUITION: Yearlong courses (two semesters): $500.00 ($475.00 if registered BEFORE June 1st.)
There is a materials fee for Art of $25.00

1st Activity/Physical Fitness Class

2nd Activity/Physical Fitness Class

TUITION: Each Full Credit Activity, $250.00 ($225.00 if registered BEFORE June 1st.)

Activity/Physical Fitness Class

Activity/Physical Fitness Class

TUITION: Each Half Credit Activity, $137.50 ($125.00 if registered BEFORE June 1st.)

PLEASE CAREFULLY REVIEW APPLICATION AND REFUND POLICY BEFORE SUBMITTING!
After submitting, within seconds, an on-line e-payment form will automatically be forwarded to you.
Note! You are NOT registered until your e-payment form is completed and sent.
A confirmation card for your class enrollment will be mailed within a few weeks.
Name of person submitting application*:

If you encounter problems, e-mail us at Eileen@wvcpas.com.