Appleton City Elementary 2024 - 2025 Enrollment
2024 - 2025 Enrollment, Emergency Contact & Transportation
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Email *
Child's Legal Last Name: *
Child's Legal First Name: *
Child's Legal Middle Name: *
Grade: *
Student's Date of Birth *
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Student's Gender
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Student's Social Security Number
Nickname (if the child goes by something other than his/ her legal name)
Home Phone Number *
Street Address *
City: *
Zip Code: *
County *
Does the child lack a fixed, regular and adequate nighttime residence, according to any of the following terms: i) sharing housing of
other persons due to loss of housing, economic hardship, or a similar reason; living in motels, hotels, trailer cars, or camping grounds
due to the lack of alternative adequate accommodations; living in emergency or transitional shelters; or are abandoned in hospitals ii)
having a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping
accommodation for human beings iii) living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train
stations, or similar settings iv) migratory child, who qualify as homeless for the purposes of this subtitle because the child is living in
circumstance described in (i) through (iii)? *
Ethnicity - Is the Student Hispanic or Latino?
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Race (check all that apply)
Do you use a language other than English?
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Is there any language other than English spoken in your home?
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Student's country of origin
Parent's country of origin
Date Entered the United States, if applicable
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Date entered school in the United States, if applicable
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Mother's / Guardian's  - Name (Last, First Middle)
Is Mother in the home?
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Mother's -  Address, if different than student's
Mother's Day Phone
Mother's Employer
Mother's Home Phone
Mother's-  e-mail address
Father's / Guardian's - Name (Last, First Middle)
Is father living in the home?
Clear selection
Father's - Address, if different than student's address
Father's Day Phone
Father's - Employer
Father's Home Phone
Father's e-mail address
Other Parent / Guardian living in the home - Name (Last, First)
Other Parent / Guardian -  relationship to child
Other Parent / Guardian -  Day Phone
Other Parent / Guardian - Employer
Other Parent / Guardian - Home Phone
Siblings: (who currently live in the Appleton City R-2 School District) - name(s), grade(s)
1st Alternate Emergency Contact Information - Name
1st Alternate Emergency Contact Information - Phone Number
1st Alternate Emergency Contact Information - Relationship
1st Alternate Emergency Contact Information - Do you authorize the district to release any and all identifiable information about your student to this person and to pick up your child on your behalf.
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2nd Alternate Emergency Contact Information - Name
2nd Alternate Emergency Contact Information - Phone Number
2nd Alternate Emergency Contact Information - Relationship
2nd Alternate Emergency Contact Information - Do you authorize the district to release any and all identifiable information about your student to this person and to pick up your child on your behalf.
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Is there anyone who is NOT to pick up your child from school or school events?  If yes, please provide that person's name and any applicable details.  Also, please provide any applicable court documents / custody papers to the school.
Is your child currently under suspension or expulsion from school?
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Has your child ever been under suspension or expulsion from school?
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If your child has ever been suspended or expelled from school, please state the reason(s)
Do you authorize Appleton City School District to send communications via phone call or text messages to the Parent / Guardian's cell phone numbers provided in this form?
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Transportation:  How will your child get to school in the mornings? *
Transportation:  How will your child go home from school in the afternoons? *
Do you have any special instructions for how your student will go home each day?
In case of early release due to bad weather or other emergency how should your child go home?  If your child should go home a different way than listed above, please provide specific details (include contact name and address) : *
Directory Information is information contained in an educational record of a student that would not generally be considered harmful or an invasion of privacy if disclosed. The Appleton City R-II School District designates the following items as Directory Information: student’s name, parents’/legal guardians’ name, address, telephone number, date and place of birth, major field of study, participation in officially recognized activities and sports, weight and height of members of athletic teams, dates of attendance, degrees and awards received, most recent previous school attended, and photograph. Student photographs, names, and special recognitions may also be published through the Appleton City School Facebook pages, other school maintained social media sources, Appleton City District Webpage, Elementary School Newsletter, and/or Local Newspaper unless the parent/legal guardian has notified the school in writing of non-consent to do so. Parents/Legal guardians or eligible students will have ten (10) days after this public notice to view the student’s directory information and to provide in writing to the school district that they choose to not have this information released. Unless notified to the contrary in writing within the ten (10) days period, the school district may disclose any of these items designated as directory information without prior consent. *
Field Trip Permission: At different times during the school year, your child will have an opportunity to take educational field trips away from the school under the supervision of school personnel.It is difficult for us to send home permission slips prior to each field trip and receive a 100% return before field trip departure time. The result is often a hasty effort to obtain last minute parent permission by telephone or a disappointed child who has to stay at school when his/her classmates go on the field trip.Field trips are generally limited to one out-of-town and one or two in-town, walking field trips per year.  A notice of time, place and method of transportation will be sent home with your child prior to each field trip.  Does your child have permission to participate in class field trips? *
Name of the Parent / Guardian Completing this form.
Verification:  On this date, I verify that the information provided on this form is accurate and current.  Submitting false statements or information relating to residency is defined as a Class A misdemeanor and the district may recover from you tuition payment for any pupil who is enrolled based on false information you provide. *
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