School Motto: “Bringing Excellence to Students”

HOME OF THE WILDCATS

Summer Cove Heights Middle School
School Year 2023-2024
Stephan V. Panikulangara Student Registration Form Mercy Stephan
Principal schmiddleschool@gmail.com | schmswildcats.weebly.com Assistant Principal

Attention parents/guardians,
There will be only two models of learning available for SY 2023-2024, Online and Face 2 Face. All students who
would like to register for the Online Model of Learning for SY 2023-2024 will need to submit the Online Selection Form to
the district school in which they are registered. All students are registered as Face to Face students unless they submit an
Online Selection Form. Once the Online Selection Option is selected it cannot be changed for the remainder of the semester,
except under extenuating circumstances and with the approval of the school administrator. 4th grade students will submit their
Online Registration form to the school that the student will be attending for SY 23-24.

Instructions: This selection form must be completed and submitted to your child’s school at (email either the school or the
principal).

DEMOGRAPHICS
Student’s Last Name: Student’s First Name: Middle Initial:

Person completing this form: (Please Print: Last Name, First Name) I am: (Check one)
o Parent / Legal Guardian
o Student (18 yrs or older)

Student Email Address: Date of Birth (DOB): Grade:

Parent/Guardian’s Last Name, First Name: Parent/Guardian’s Email Address:

Full Physical Address (House#, Street Name, Zip Code): Mailing Address (Include City and Zip Code):

HOME: WORK: CELL:

MODEL OF LEARNING INFORMATION

PLEASE SELECT THE MODEL OF INSTRUCTION YOU PLEASE INDICATE IF YOUR CHILD REQUIRES A
WOULD LIKE TO PARTICIPATE IN. LAPTOP FOR SUMMER SCHOOL.
o Face-To-Face Model of Learning o YES
o Online Model of Learning o NO

TECHNOLOGY INFORMATION
LAPTOP INTERNET ACCESS
o My Child does not require a laptop.
PLEASE INDICATE IF YOUR CHILD DOES HAVE A
RELIABLE INTERNET AT HOME.
o My Child will need a Laptop for Online MOL
o YES
(Please complete Student Device Application)
o NO

Summer Cove Heights Middle School’s mission is to aim to provide a safe learning environment with a welcoming atmosphere which creates a sense of belonging
amongst the families. We maintain an inclusive environment which acknowledges and respects children from diverse family and cultural backgrounds.