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Moore County Schools Student Registration Form 2020-2021
Please complete this form to register your child for the 2020-2021 school year.
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* Indicates required question
Student's Legal Name (First Middle Last)
*
Your answer
Social Security #
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
City of Birth, State of Birth
*
Your answer
Name of primary parent/guardian with whom the student lives
*
Your answer
Address of primary parent/guardian with whom the student lives
*
Your answer
Cell phone number of primary parent/guardian with whom the student lives
*
Your answer
Email address of primary parent/guardian with whom the student lives
Your answer
Name of secondary parent/guardian
Your answer
Address of secondary parent/guardian
Your answer
Cell phone number of secondary parent/guardian
Your answer
Full Name of Mother
Your answer
Mother's Maiden Name
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Place of Employment
Your answer
Work Phone
Your answer
Full Name of Father
*
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Place of Employment
Your answer
Work Phone
Your answer
The school sends Remind alerts for school events and closures. What phone number would you like to be contacted?
*
Your answer
Grade student is enrolling in for the 2020-2021 school year.
*
Choose
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Year student entered 9th grade (if enrolling at MCHS)
Your answer
Enrollment
*
Choose
New Enrollment
Re-enrollment
Gender
*
Choose
Male
Female
Ethnicity
*
Asian
Black
Hispanic
Native American
Pacific Islander
White
Are there any siblings of the student enrolled in Moore County Schools?
*
Yes
No
If "yes" please list names and grades of siblings.
Your answer
Mode of Transportation (Check all that apply.)
*
Bus rider
Car rider or student driver
Walker
ESP
Required
If Bus Rider, AM Bus #
Your answer
If Bus Rider, PM Bus #
Your answer
Is either parent/guardian enlisted in the military?
*
Yes
No
If "yes" please check which one.
Choose
Active Duty Military
National Guard Military
Reserve Military
Are there any custody issues of which we should be aware?
*
Your answer
*If there are custody issues, please provide a copy of the court papers to the school within the first week of enrollment.
Name of emergency contact #1 (other than a parent)
*
Your answer
Address and phone number for emergency contact #1
*
Your answer
Name of emergency contact #2 (other than a parent)
Your answer
Address and phone number for emergency contact #2
Your answer
Is English the student's primary language?
*
Yes
No
If no, what language is spoken?
Your answer
Is the enrolling student a foster child?
*
Yes
No
Is the enrolling student experiencing homelessness?
*
Yes
No
Is the student covered under a Private Insurance Company or TennCare? Please list carrier.
*
Your answer
Medical concerns for the enrolling student. *Include all food allergies.
Your answer
Name and address of last school attended
Your answer
Was the school last attended a public or private school?
Public
Private
Clear selection
Is the student currently suspended or expelled from another school?
*
Yes
No
If yes, what is the last day of suspension?
MM
/
DD
/
YYYY
Is student currently participating in an alternative school program?
*
Yes
No
The student has been enrolled in the following special programs (check all that apply):
Special Education
Speech
504
ESL
Homeless
Migrant
Other:
Parent or guardian's name completing this form.
*
Your answer
Today's Date
*
MM
/
DD
/
YYYY
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