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New Student Application (Instance: new, Process: Student_Registration, Version: 1, Step: 1)
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Instructions:
Please enter student information.
All fields in red require input.
Click on "Send" button when complete.
Student Information
 
As appears on Birth Certificate
As appears on Birth Certificate
As appears on Birth Certificate
 MM/DD/YYYY
As appears on Birth Certificate
 
Please Check at least one
*one selection is required.
  
  
  
  
  
 
Home Language Survey
Student Residence / Home
 
I understand that if the District determines that the above address is not my legal residence for purposes of enrollment of my child(ren) in school in this District, that I may be subject to legal action and the payment of any tuition charges for the period of time that my child was enrolled as a non-resident student.
Previous Education
 
 (mm/dd/yyyy)
 
 
Please Check All that Apply
  
  
  
  
 
Please Check All that Apply
  
  
  
 
Parent/Guardian/Custody Information
Please Check All That Apply:
  
  
  
  
  
  
  
  
  
Primary Contact
Primary contact is the person (or persons) responsible for the regular care of the student and to whom the school may send school-related correspondence. The primary contact is also the first point of contact for the school in the unlikely event that the child is injured or becomes ill while at school. In general, the Primary Contact refers to the parent(s) or guardian(s) of the student and will likely be duplicated from the Family Data Section.
  
 
Phone Number(s)
Phone Type Phone Number
  Add row(s)  Delete selected row(s) 
To add row click on +
to delete select checkbox for row and click on -
 
 
Please Check All that Apply
  
  
  
  
  
  
In the event that the school is unable to reach the Primary Contact, parents are encouraged to provide at least one and up to 5 additional contacts whom the school may call in the unlikely event that this student is injured or becomes ill while at school.
 
IMPORTANT NOTE: Primary and additional contacts are the only persons authorized to pick up a child from school. As a result, please create an additional contact below for those individuals whom you authorize to pick up your child from school in place of a parent or legal guardian.
A photo ID will be required at the time of pick-up.
Additional Contact (1)
Additional person whom we may contact in an emergency situation
 
  
 
Phone Number(s)
Phone Type Phone Number
  Add row(s)  Delete selected row(s) 
To add row click on +
to delete select checkbox for row and click on -
 
 
Please Check All that Apply
  
  
  
  
  
  
 
Additional Contact (2)
Additional person whom we may contact in an emergency situation
 
  
 
Phone Number(s)
Phone Type Phone Number
  Add row(s)  Delete selected row(s) 
To add row click on +
to delete select checkbox for row and click on -
 
 
Please Check All that Apply
  
  
  
  
  
  
 
Additional Contact (3)
Additional person whom we may contact in an emergency situation
 
  
 
Phone Number(s)
Phone Type Phone Number
  Add row(s)  Delete selected row(s) 
To add row click on +
to delete select checkbox for row and click on -
 
 
Please Check All that Apply
  
  
  
  
  
  
 
Additional Contact (4)
Additional person whom we may contact in an emergency situation
 
  
 
Phone Number(s)
Phone Type Phone Numbe
  Add row(s)  Delete selected row(s) 
To add row click on +
to delete select checkbox for row and click on -
 
 
Please Check All that Apply
  
  
  
  
  
  
 
Additional Contact (5)
Additional person whom we may contact in an emergency situation
 
  
 
Phone Number(s)
Phone Type Phone Number
  Add row(s)  Delete selected row(s) 
To add row click on +
to delete select checkbox for row and click on -
 
 
Please Check All that Apply
  
  
  
  
  
  
 
District-wide Notification System
This phone number will be used for attendance phone calls, district news and emergency notifications.
Child Medical Care
Primary Medical Contact(s)
Primary Physician
Dentist
Medical Specialist
Preferred Hospital / ER
Medical Conditions and Special Care
Please provide information about medical conditions your child has, special care that may be required for your child while at school or school events, and/or medications your child takes. This information, which will remain confidential, will be helpful to the school staff in the unlikely event that your child is involved in an emergency while at school or at a school-sponsored event.
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Check here if special care or administration of medication may be required at school. Additional requests for information will be sent home by the district medical staff.
Child Care Provider
Child Care Provider Information
Transportation
CONSENT - Part I or Part II must be completed
GRANT CONSENT
In the event that reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by above-named doctor, or, in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinion of two (2) other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.
REFUSAL TO CONSENT
I do NOT give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the school authorities to take the following action:
Annual Parent Notifications & Consents, valid for above selected school year
  Click for Info
  Click for Info
  Click for Info
  Click for Info
  Click for Info
Below is a checklist-please bring these items to your appointment
If you own:
Current Utility Bill with Service Address

If you rent:
Rent or Lease Agreement with Landlord’s Contact Information & Current Utility Bill with Service Address
  Click here to download Immunization form
  Click here to download Home Language Survey
  Click here to download Permission for Release of Records form
  Click here to download a Free and Reduced Lunch Application
 
After completion, please schedule an enrollment appointment when prompted to do so, or contact the Registration Department at 330-915-5300.
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