LaSalle Peru Area Career Center Registration

Counselor (Please Choose) *

Select Home School Of Student Entering *

Class Next Year *

Select the Class to Enroll In

Did Student Attend ACC Last Year? *

Student SIS#

Will the student be graduating early (only attending the ACC for first semester)?

Check Box if answer to above question is yes.

Please enter a working email address for the parent or guardian of the student registering. *

Re-enter email address *

Student First Name *

Student Last Name *

Gender

Address *

City *

State *

Zip Code *

Phone Number *

Emergency Notification Number 🛈

Student Birthdate (mm/dd/yyyy) * +

Age (Yrs) *

Parent/Guardian Name *

Does the student have an IEP or 504 plan that will be used at the ACC? *

Yes

No

Is it acceptable to photograph this student? *

List any Physical or Medical Conditions to be aware of (Enter N/A if there are none). Click + after each condition entered to add multiple conditions.

+-

Primary Physicians Name *

Physicians Phone Number *

Secondary Physicians Name

Physicians Phone Number

In case of emergency; what hospital should student be sent to? *

Contact Person: (Enter Full Name, Relationship, and Primary Phone Number). To enter multiple people, press the + symbol after each person entered.

+-

Required: Click Link Directly Below for Internet Usage Contract (Must be signed and returned to ACC Directors Office--Please give signed copy to your counselor)

Computer Usage Contract (Please read , print, sign , and return to your counselor. <--Click Here

As a part of the standard ACC curriculum your child will attend field sessions that take him or her outside of the Area Career Center. These field sessions will take place within the immediate Illinois Valley Area. By checking this box you consent to your child's involvement in these field sessions. Any field trip that goes outside of the Illinois Valley Area will require your child to bring home a formal field trip permission slip. Checking this box affirms your consent ,on an ongoing basis, for the routine field experiences within the Illinois Valley and foregoes the necessity of a formal field trip form being sent home. *

I consent

The LaSalle Peru Area Career Center(LPACC) operates on a limited enrollment basis. This means that each class has a certain number of reserved seats. When a student accepts enrollment in an ACC class there may be additional students who are on a waiting list to get into that class. For this reason the ACC has a strict 10 day absence limit. Any student who exceeds the 10 day absence limit will be recommended for enrollment in an attendance remediation program. This program will be administered between the students home school and the ACC. By checking the box below you are indicating that you have read this clause and understand its ramifications as it pertains to maintaining enrollment in the ACC. Failing to check this box will cause the form to be returned to the parent and student, and could jeopardize enrollment in the LPACC. *

I consent

Is this student required to be on an asthma plan? (If so, the ACC will need to have a copy of that plan on file, check N/A for non-asthmatic children) *

Yes

N/A

Parents if you could please sign the box below electronically with your mouse ,stylus, or finger. Then when you print the form (which will be sent to the email address you entered), please re-sign with pen. This will allow the signature to have better legibility. Turn the signed form into your child's school counselor. *

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