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21st Century Registration 2020-2021
LINCOLN COUNTY HIGH SCHOOL
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* Indicates required question
Student's Full Name
*
Your answer
Address, City, Zip
*
Your answer
Phone
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Choose
Male
Female
Grade
*
9th
10th
11th
12th
Race
*
African American (Not of Hispanic Origin)
American Indian/Alaskan Native
Asian
Caucasian (Not of Hispanic Origin)
Hispanic
Native Hawaiian or Pacific Islander
Two or More Races
Student Lives With
*
Both Parents
Single Mother
Single Father
Joint Custody
Guardian
Foster Care
Grandparents
Parent/Guardian Name
*
Your answer
Parent/Guardian Email
*
Your answer
Parent/Guardian Phone
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone
*
Your answer
Emergency Contact Relationship
Your answer
If school transportation is available, my student will
Be picked up at school by adult (authorized above)
Be picked up at a local elementary school
Other:
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If child is being picked up at a local elementary school, which elementary school will they be picked up at?
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Choose
Crab Orchard Elementary
Highland Elementary
Hustonville Elementary
Stanford Elementary
Waynesburg Elementary
N/A
Does your student have any physical limitations, special needs, and/or food allergies?
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Your answer
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