Scott County District 2 Enrollment Form

Open Enrollment Closes on August 31, 2023 at 11:59 PM EST

Hours

Minutes

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Confirm Email

How many students/devices are you registering? *

Student Name *

First

Last

Student Grade *

Student Name #2 *

First

Last

Student Grade #2 *

Student Name #3 *

First

Last

Student Grade #3 *

Student Name #4 *

First

Last

Student Grade #4 *

Total

$ 0.00

Acknowledgement: *

I acknowledge that my device is covered from 8/01/2023 (or date of coverage purchase) through 7/31/2024. If my device is damaged before 8/01/2023, or before coverage is purchased, this ADP coverage does not apply.

Authorize.Net *

Card Number

Expiration

Security Code