Name________________________________________________________________________

(Last)

(First)

(Middle)

Home Address_________________________________________________________________

City, State, Zip Code____________________________________________________________

Home Phone__________________________ Emergency Phone__________________________

E-mail Address________________________________________________________________

Date of Birth (MM/DD/YY)__________________________Gender M / F

Is this the first time you will attend Rice's Summer School? Y / N

Mother's Name_________________________ Daytime Phone______________________

Father's Name__________________________ Daytime Phone______________________

Parent's E-mail Address_____________________________________________________

School you will attend in Fall 2008____________________________________________

Grade level this Fall (2008)______________________________________________

Phone number of school ____________________________________________________

Address of school__________________________________________________________

City, State, Zip Code of school________________________________________________

________________________________________________________________________
Evaluations for Enrichment students and grades for credit students will be mailed to parents and school . (Please make sure that the addresses are complete.)

I understand that classes at Summer School are regularly videotaped for professional purposes.   

I release and hold harmless Rice University including, but not limited to, its trustees, officers, employees, representatives, agents and affiliates, from any and all claims, liabilities, damages, personal injuries, and damage to or loss of personal property arising, directly or indirectly, in connection with my child's participation in the program.    I certify that my child has medical/hospitalization

insurance with ____________________________________________________________company,   

policy number ____________________________________________________________________,

policy holder's social security number (optional) ________________________________________.

In the event of no insurance coverage:

Insurance may be purchased through Rice University for $26.50. Please submit a check made out to Rice University in the amount of $26.50 should you wish to purchase this insurance. A copy of the policy will be sent to you in the mail for your records. Students without insurance coverage will not be eligible to attend Rice Summer School for Grades 8 through 12.

I understand that should my child require medical treatment, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I consent to such treatment for my child as may be deemed necessary under the circumstances, including, but not limited to, x-ray examinations, surgery and anesthesia. Any expense not covered by insurance shall be my sole responsibility. In the event of injury I authorize the release of all medical records concerning my child, in the possession of Rice University EMS, for the purpose of continuation of care. I release Rice University and Rice University EMS as the custodian of such records, from any and all liability.

RULES: Rice Summer School works to provide a challenging and enriching academic program for students. In that effort, we require the collaboration of students, parents, teachers, and staff in abiding by and enforcing the following regulations:   

1)  As guests, all participants must respect other people and all property and must follow the policies and rules of the campus.

2)  Students are not permitted to smoke or have skateboards, roller blades, any electronics that make noise, or weapons on the campus. Students will be expected to comply with Texas law and the policies and rules of the Summer School at all times.

3)  Students must be in their assigned classrooms except during passing periods or breaks.

4)  Enrichment students must leave the Rice campus by 12:15 PM. Credit students must leave the St. John's School campus by 3:15 PM

Withdraws requires the written consent of a parent or guardian. Violation of any of these regulations or other inappropriate or disruptive behavior, including, but not limited to, behavior deemed by the Summer School as threatening, dishonest, malicious, endangering people or property or disruptive to the program, may result in a student's immediate removal from the program. The Summer School reserves the right to refuse to register any applicant. Further, should the enrollment of the student be deemed an inappropriate placement for any reason, including behavioral issues, the student will be withdrawn from the program.    By signing below I certify that I understand and agree to abide by (i) the policies of the Summer School, including its policy on refunds, (ii) the release of liability and medical authority as set forth above, and (iii) the rules listed above, and (iv) release of evaluations to the school listed on this application as the school that the student intends to attend this fall.

Parent’s Signature ________________________________________ Date_________________

Fill out the appropriate section(s) for the Skills and Enrichment programs. No guarantee can be given that you will get your first choices, but every effort will be made to secure them for you. List only the choices you will accept for each time period. Applications will be processed in the order in which they are received (first come, first served). Deadline for submitting applications without a late fee is May 16 .

CLASS SELECTIONS

SKILLS COURSES (Optional)
Monday - Friday, 8:00 AM - 8:50 AM

You may take one skills course if you are enrolled in the enrichment program. Please list the title and number of two choices in order of preference. Skills courses are optional.

1st Choice _____________________________ 2nd Choice ____________________________

ENRICHMENT COURSES
Monday - Friday, 9:00 AM - 11:50 AM

List the number and title of up to three courses in order of preference for each period. Please make second and third choices carefully as they will be assigned if your first choice is not available.

TUITION AND FEES

SKILLS AND ENRICHMENT:

APPLICATIONS ACCEPTED BY MAIL ONLY through April 16, 2008. Applications accepted by mail or in person from April 17 through May 16, 2008. Applications will be accepted between May 17 and June 4 with a late fee of $50. Office hours are 9 AM to 3 PM, Monday - Friday.

Submit a deposit of $200 for the enrichment program and optional skills course. The balance of $550 is due by May 23. Make checks payable to Rice University. We do not accept credit cards.

PLEASE COMPLETE THIS APPLICATION AND SUBMIT WITH PAYMENT TO:

Rice University
Summer School for Grades 8-12, MS-145
P.O. Box 1892
Houston, TX 77251-1892 ________________________________________________________
______________________________________________

CREDIT COURSES
Monday - Friday, 8:00 AM - 3:00 PM
Credit courses will be held at St. John's School located at 2401 Claremont, Houston TX 77019

Course Requested_________________________________________________________________________

By signing below. I understand that credit for the Credit Program in the Rice University Summer School is awarded through Spring branch ISD and further certify that I understand and agree to the release of evaluations and grade reports to the school listed on this application as the school that the student intends to attend this Fall.

Parent’s Signature_______________________________________________Date________________________

I certify that this student has met the course prerequisites and academic requirements and has not previously taken the course. The student understands the policy of the school on accepting credit from Rice University Summer School. (See page 13.) (Only students who are well prepared and who understand the rigor and intensity of Summer School credit classes, especially those courses designated for PreAP, AP, and honors credit, should be recommended to this program.)

__________________________________________________________________________________
High School Principal's Signature and Date

__________________________________________________________________________________
Counselor's Signature and Date

__________________________________________________________________________________
Current Teacher's signature for the subject area requested and Date

TUITION AND FEES

CREDIT:

PRE-REGISTRATION WILL TAKE PLACE ONLINE THURSDAY, APRIL 10, 2008 AT 5:00 PM.. After preregistration has taken place, students will have ten (10) days in which to submit this completed application form, with all required signatures. If payment was not made at time of online preregistration a check in the amount of $800 ($825 for Chemistry students) must accompany the completed application. Make checks payable to Rice University.

Application will not be processed until all required items (completed application with signatures of Teacher, Counselor and Principal) and full payment of $800 is received in this office at the below address:

Rice University
Summer School for Grades 8-12, MS-145
P.O. Box 1892
Herman Brown Hall, Room 28
Houston, TX 77251-1892

_________________________

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