Credit Recovery Course Registration

Ebersole Center's Credit Recovery Course:

Who is eligible to attend? Any currently enrolled Lansing School District student that has previously attempted and failed a course. If demand for these courses exceeds the available seats, priority will be given to students in the 2023 and 2024 graduating cohorts.
What is included in this opportunity? The Lansing School District is excited to offer Ebersole Credit Recovery Courses. Participating students will be provided transportation and food for the duration of the course. Note that these are overnight experiences which requires a commitment for the full duration of the course.
When will these courses take place? We offer courses throughout the year. Our next course will take place during Spring Break from March 27-31, 2023.
Where will these courses take place? These courses will take place at the Lansing School District's Ebersole Center located in Wayland, MI.
Where can I register my student for these courses? If you continue scrolling down you will see the course registration.

Directions: Thank you for your interest in the Ebersole Credit Recovery Courses. By completing this form, you are one step closer to achieving your goal of graduation. Please fully complete, and submit, the registration form below. Should you have any additional questions or concerns please do not hesitate to contact me at 517-755-5001.

Access the Packing List for the Ebersole course.

With gratitude and appreciation, Ben Botwinski (Ebersole Director)

Ebersole Credit Recovery Course Registration

Please select the learning opportunity you, or the student you are registering, are interested in attending:

Which course(s) are you most interested in recovering credits during this learning opportunity? Please be as specific as possible.

PART I: STUDENT'S INFORMATION

Student's Last Name:

Student's First Name:

Student's Date of Birth (MM/DD/YYYY):

Student's ID #:

Student's Gender:

Student's School (for 2022-23):

Student's Grade Level (for 2022-23):

Parent/Guardian's Last Name:

Parent/Guardian's First Name:

Parent/Guardian's Primary Phone:

Parent/Guardian's Email Address:

PART II: STUDENT'S EMERGENCY CONTACTS

Special Note: We will assume that the PRIMARY Emergency Contact is the parent/guardian listed above.

(Secondary) Emergency Contact's Last Name:

(Secondary) Emergency Contact's First Name:

(Secondary) Emergency Contact's Relationship to the Student:

(Secondary) Emergency Contact's Phone:

PART III: STUDENT'S PRIMARY MEDICAL CARE & MEDICAL INSURANCE

Does this student have a primary care doctor?

If YES, please provide the name of this student's primary care doctor:

If YES, please provide the phone number of this student's primary care doctor:

Is this student covered by medical insurance?

If YES, please provide the name of the medical insurance company:

If YES, please provide the phone number for the medical insurance company:

If YES, please provide the relevant medical insurance policy number:

If YES, please provide the name of the SUBSCRIBER for the medical insurance policy: The SUBSCRIBER is the individual who's name the medical insurance is under. This is usually the person who's name is on the medical insurance card.

PART IV: STUDENT'S IMMUNIZATIONS

Are all of the student's immunizations up to date?

If NO, please initial the box below acknowledging that you understand and accept the risks to your student from not being fully immunized.

Please provide the month and year of the student's last tetanus immunization (MM/YYYY):

PART V: STUDENT'S ALLERGIES

Is this student allergic to any food, medication, or insect stings?

If YES, name the item(s) that this student is allergic to and indicate the reaction.

Item #1: My student is allergic to:

My student's reaction to Item #1 is:

Item #2: My student is allergic to:

My student's reaction to Item #2 is:

Other allergy related information about the student that we may need to know about:

PART VI: STUDENT'S ASTHMA

Does this student have medically-diagnosed asthma that requires you to send an inhaler to camp?

If YES, does the student need staff help to use their rescue inhaler?

If YES, what triggers the student's asthma?

PART VII: STUDENT'S DIET & SLEEPING HABITS

Select all that apply to this student's diet. This student eats a vegetarian diet. This student has a lactose intolerance. This student has a gluten intolerance.

Any other dietary information about this student that we should know about:

Select all that apply to this student's sleeping habits. This student is prone to sleep walking. This student is prone to bedwetting. This student is prone to rolling out of bed.

Any other sleep-related information about this student that we should know about:

PART VIII: STUDENT'S CHALLENGES

Please share any information about physical difficulties you think are important for us to know about or that may impact this student's ability to fully participate in camp activities:

Please share any information about mental, emotional, or social difficulties you think are important for us to know about or that may impact this student's ability to fully participate in camp activities:

PART IX: STUDENT'S MEDICATIONS

Special Note: A Health Officer is staffed on-site at the Ebersole Center 24 hours a day when students are present. The Health Officer is responsible for distributing all medications to students.

Special Note: All medication listed on this form must come with the student. All prescriptions - including inhalers and EPI-Pens – MUST be in the original box or bottle showing the student's name, what time the medication is taken, and the dose.

Special Note: Medication is any substance a person takes to maintain and/or improve their health. This includes vitamins and natural remedies. Please provide enough of each medication to last the entire time the student will be at camp. Expired prescriptions will not be dispensed.

Student's Medications: (required) NO, this student will not take any daily medications while at camp. YES, this student will bring an inhaler or EPI-Pen to camp. YES, this student will take the following daily medications while at camp.

Name of Medication #1:

Medication #1 - Amount or Dosage:

Medication #1 - Reason for Taking:

Medication #1 - Given at:

Name of Medication #2:

Medication #2 - Amount or Dosage

Medication #2 - Reason for Taking:

Medication #2 - Given at:

Name of Medication #3:

Medication #3 - Amount or Dosage

Medication #3 - Reason for Taking:

Medication #3 - Given at:

Please provide any additional medication related information about this student that you think we should know about:

PART X: STUDENT'S PHOTO RELEASE

The Lansing School District occasionally use photographs and/or video of students for promotional purposes through broadcast, print, or social media. Please review the options and select one that best describes your wishes in regards to CAMP photo and video usage. (required) YES, it is alright for the Lansing School District to use CAMP photos and/or video of my student for promotional purposes through broadcast, print, and/or social media. NO, it is not alright for the Lansing School District to use CAMP photos and/or video of my student for promotional purposes through broadcast, print, and/or social media.

PART XI: PARENT/GUARDIAN'S ACKNOWLEDGEMENTS

(A) Please initial to acknowledge that the information contained in this form is correct and accurately reflects the health status of the student to whom it pertains.

(B) Please initial to acknowledge that this student has permission to participate in all camp activities.

(C) Please initial to acknowledge that you understand the information on this form will be shared on a “need to know” basis with camp staff, and that you give permission to photocopy this form.

(D) Please initial to acknowledge that you understand that if your student needs to be sent home due to illness, injury, or disciplinary reasons, that you are responsible for picking your student up.

(E) Please initial to acknowledge that you understand that the camp has limited health care onsite and that staff will call the indicated parent/guardian in an emergency and/or if your student is unable to continue because of injury or illness.

(F) Please initial to acknowledge that you give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to the health of your student in emergency situations.

(G) Please initial to acknowledge that if you cannot be reached in an emergency, you give your permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this student.

Special Note: If there is a religious objection to consenting to receipt of emergency medical or surgical treatment, the authorized person shall submit a written statement to the effect that the student is in good health and that the person signing assumes the health responsibility for the student.

Special Note: State of Michigan licensing rule 400.11127(2) states that a camp shall maintain, in the camp, a health history statement signed by an authorized person for each student and minor staff person.

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11,500 Enrollment by 2025

85% Graduation Rate by 2025

90% Attendance by 2025