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Student First Name
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Student Last Name
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Date of Birth
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(mm/dd/yyyy)
Gender*
Male
Female
2026-27 Grade*
9
10
11
12
Student Phone
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Student JSerra Email
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Parent First Name
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Parent Last Name
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Parent Email
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Parent Phone
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SEMESTER 1 COURSES
Arts
AP Art History
Graphic Design
History of Rock and Roll
English
English 1 (remediation only)
English 2
English 3
English 4
Math
Algebra 1
Algebra 2
AP Statistics
Geometry
Science
Biology
Chemistry
Environmental Science
Physics
History
AP Human Geography
Economics
US Government
US History
World History
World Languages
French
French 2
French 3H
French 4
Latin 1
Latin 2
Latin 3H
Spanish 1
Spanish 2
Spanish 3H
Spanish 4H
Chinese 1
Chinese 2
Chinese 3H
American Sign Language (ASL) 1
American Sign Language (ASL) 2
American Sign Language (ASL) 3
SPANISH 2 - SEMESTER 2 (pre-authorized enrollees only)
SPANISH 3 - SEMESTER 1 (pre-authorized enrollees only)
SPANISH 3 - SEMESTER 2 (pre-authorized enrollees only)
SPANISH 2/3 Passcode
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required
You must be pre-authorized through your counselor to enroll in these classes. Please enter the passcode provided to you by your counselor below.
P.E.
Health
Personal Fitness 1
Personal Fitness 2
Electives
AP Computer Science
AP Art History and Criticism H
Digital Information Technology
Foundations of Programming
Guitar
Journalism
Psychology
AP Psychology (e-text not included)
SEMESTER 2 COURSES
Arts
AP Art History
Graphic Design
History of Rock and Roll
English
English 1 (remediation only)
English 2
English 3
English 4
Math
Algebra 1
Algebra 2
AP Statistics
Geometry
Science
Biology
Chemistry
Environmental Science
Physics
History
AP Human Geography
Economics
US Government
US History
World History
World Languages
French
French 2
French 3H
French 4
Latin 1
Latin 2
Latin 3H
Spanish 1
Spanish 2
Spanish 3H
Spanish 4H
Chinese 1
Chinese 2
Chinese 3H
American Sign Language (ASL) 1
American Sign Language (ASL) 2
American Sign Language (ASL) 3
P.E.
Health
Personal Fitness 1
Personal Fitness 2
Electives
AP Computer Science
AP Art History and Criticism H
Digital Information Technology
Foundations of Programming
Guitar
Journalism
Psychology
AP Psychology (e-text not included)
Full-time JSerra Employee?*
Yes
No
Name of JSerra Employee:
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required
How many courses?*
1
2
3
4
2025-26 Employee Code
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required
TOTAL
Handbook Acknowledgement - Parent Signature
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required
I understand that it is my responsibility to read and adhere to all policies and procedures as outlined in the JSerra Online Education Handbook below.
Download Online Education Handbook
On-Campus Finals Acknowledgement*
Parent/Guardian and Student understand that all semester finals must be taken in person on campus.
Yes
No
Course Inactivity Acknowledgement*
Parent/Guardian and Student understand that student inactivity exceeding 14 days may result in administrative removal from the course. In case of administrative removal, student will earn a WF (Withdrawal Fail) and be ineligible for a refund.
Yes
No
Course Completion Acknowledgement*
Parent/Guardian and Student understand that 100% of the course must be completed, with zero missing assignments, prior to taking the final. Course work must be completed in modular sequence, without omitting or skipping assignments. We understand only one Discussion Based Assessment (DBA) is allowed per day and no assignments or DBAs will be accepted on the day of the final. If the entire course is not 100% complete prior to the day of the final, student is not eligible to take the final exam and will earn a WF (Withdraw Fail).
Yes
No
Course Seat-Time Acknowledgement*
Parent/Guardian and Student understand a minimum of 14 days of seat-time, represented by consistent course participation and submission of assignments, is required to earn credit for the course.
Yes
No
No Course Extension Acknowledgement*
Parent/Guardian and Student understand that all assignments must be completed by due dates and 100% of the course must be completed prior to the day of the final. No extensions, regardless of length, are permitted.
Yes
No
Asynchronous and Live Lesson Acknowledgement*
Parent/Guardian and Student understand that online courses are operated as asynchronous courses. Meaning that the student and teacher will look at the course materials at different times over a long period of time. There is not daily live instruction. The parent/student are welcome to hire a tutor if need be. Any live lessons that may take place are for the registered student only. Parents, guardians, tutors, etc., are not permitted to attend any live course instruction or DBA's (Discussion Based Assessments).
Yes
No
Withdrawal/Refund Policy Acknowledgement*
Parent/Guardian and Student understand that there are NO REFUNDS once a student is granted access to an online course. The JSerra Online department must pay up front for all online licensures. A student may withdraw from an online class, without penalty to his/her transcript, if the class is dropped prior to the JSerra add/drop date and less than 20% of the course work has been completed.
Yes
No
Please send a confirmation email to the address below*:
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