Registrar’s Office
411 N Grand Ave
Lansing, MI 48933
Phone: 517-483-1200
Last Name:
First Name:
Banner ID/Username:
Date of Birth:
Name of School: (Write
Home School”
if Home Schooled)
Anticipated High
Graduation Date:
Effective Semester:
(Check All That Apply)
Fall 20
ugust December)
____ Spring 20
(January May)
____ Summer 20
(May August)
Note to Parents/Legal Guardians and Students
It is the responsibility of the student to provide this form to the Registrar’s Office prior to enrollment in classes.
Students who register prior to submitting this form are subject to being dropped from their courses. This form will
remain in effect until the end of the semester in which the student reaches the age of 18. LCC requires basic skills
assessment for all new students. A student may audit or take the course(s) for credit.
Parent/Legal Guardian Name (Please Print)
Daytime Phone:
Address: (If Different from Student Address)
Email Address:
Signature: Date:
Completed forms may be emailed, mailed (see address at the top of the page), or delivered in person at the StarZone in the Gannon
Building. Please allow two business days for processing.
please contact the Registrar’s Office at or 517-483-1200, Option 2.
Parent/Legal Guardian Approval
I confirm that my student will be a high school graduate and at least 16 years of age on the first day of the
semester. Furthermore, I will assume financial responsibility for any and all costs associated with my child’s
attendance at Lansing Community College, if not covered by other means. I waive any claim against LCC for injury,
loss, or damage whatsoever, caused by any person rendering any services of the program caused by outsiders. I
understand that my student is participating in an adult education environment and I hereby assume responsibility
and hold LCC harmless for any adverse consequences of that participation. I understand that enrollment is
contingent upon an available open seat in the course(s) selected.
Note : If you are under the age of 18 and have graduated from high school and are considered legally independent,