K-12 Registration Form (New students)
*This form is for NEW STUDENTS only.  If your child already attends NR-S, there is no need to fill out this form.  Thanks!
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Child's Full Name (First, Middle, Last) *
Date of Birth *
MM
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DD
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YYYY
Sex *
Grade Level *
Ethnicity (check one) *
Race (check one) *
Reporting Ethnicity (check one) *
Home Address *
Transportation Requested *
If your student is transferring from another school, please provide the name of the previous school, City and State.
Last date of attendance of previous school
MM
/
DD
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YYYY
Parent E-mail Address *
Mother's Name  (First, Last) *
Mother's Home address (if different from child)
Mother Home Phone *
Mother Work Phone *
Father's Name (First, Last) *
Father's Home address (if different from child)
Father Home Phone *
Father Work Phone *
Step-Parent Name (First, Last)
Step-Parent Home Phone
Emergency Contact #1 (First, Last) *
Person to contact in the event that either parent/guardian cannot be contact)
Contact #1 Phone Number *
Emergency Contact #2 (First, Last) *
Person to contact in the event that either parent/guardian cannot be contact)
Contact #2 Phone Number *
Child's Living Arrangements *
Child's Legal Guardian *
Please provide legal documentation
Is your student on an IEP (Individualized Education Plan)? *
Is your student on a 504 Plan?
Clear selection
Is your student on an ILP (Individualized Language Plan)?
Clear selection
Is this student the youngest family member enrolled in this District? *
Health Issues
Asthma, Diabetes, Hearing, Heart Problems, Seizures, Vision, Allergies, etc.
In case of a medical emergency, and I cannot be reached, I give my child's doctor or any attending physician permission to medical treatment. *
Certification *
By checking this box, I certify that I am the parent/legal guardian of the student herein names.  I understand that if I am someone other than that student's parent/legal guardian, New Rockford-Sheyenne School District has the right to take any legal action relative to fraud.  I further understand that if I am not the student's parent or legal guardian, that New Rockford-Sheyenne School District may take disciplinary action against the student herein named.
Required
Notice *
By checking this box, I certify that I am aware of the following notice:  The New Rockford-Sheyenne School District does not discriminate on the basis of race, color, national origin, sex, disability, age or any other status protected by law.  District policy AAC.  The following person has been designated to handle inquiries regarding the non-discrimination policies:  Jill Louters, Superintendent, 437 1st Ave. N., New Rockford, ND, 701-947-5036.  For further information on notice of non-discrimination, visit:  https://www.hhs.gov/civil-rights/index.html for the address and phone number of the office that serves your area, or call 1800-421-3481.
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