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New Student Registration
New Student Registration

New Student Registration

Last Name: *

First Name: *

Middle Name:

Street Address or PO Box: *

City: *

State: *

Zip Code: *

Telephone: *

Cellphone: *

Township: *

Date of Birth: *

Month

Day

Year

Gender: *

Grade: *

Race/Ethnicity (For State Reporting Purposes)

A. Is this student Hispanic or Latino (choose only one): *

Yes, Hispanic or Latino

No, not Hispanic or Latino

B. Is this student: (Choose one or more. You must select at least one.): *

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Place of Birth

City: *

County: *

State: *

Miles from School (one-way): *

Will student ride the bus?: *

Give name of nearest neighbor or other means of locating your home: *

Are there any court documents that we should be aware of?: *

Family Structure (List brothers and sisters of child)

Name (first & last): *

Age: *

Sex: *

Grade in School: *

Name (first & last):

Age:

Sex:

Grade in School:

Name/Address of father: *

Is father living?: *

Yes

No

Occupation: *

Name/Address of mother: *

Is mother living?: *

Yes

No

Occupation: *

Do parents live together?: *

Yes

No

Divorced?: *

Yes

No

Separated?: *

Yes

No

With whom does the child live?: *

Name and Address of Previous School: *

Parent/Guardian's Electronic Signature: *

Today's Date: *

Month

Day

Year

Starting Date: *

Month

Day

Year

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