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NEW STUDENT PRE-REGISTRATION FORM
Welcome to Monhegan Island School! We a happy that you are considering entrusting us with your child's education.
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* Indicates required question
Email
*
Your email
Student: First Name
*
Your answer
Student: Middle Name
Your answer
Student: Last Name
*
Your answer
Student: Date of Birth
*
MM
/
DD
/
YYYY
Grade in School
*
Choose
Pre-K
K
1
2
3
4
5
6
7
8
Primary Monhegan Physical Address
*
Your answer
Other Mailing Address
Your answer
Student Insurance
*
Mainecare
Private Insurance Policy or Insured through parent's employer policy
NONE
Other:
Please describe the student's custodial situation, and provide required legal document if any.
*
Shared custody parents living together with no separation or divorce
Shared custody per court order (provide legal document)
Sole custody to mother (provide legal document)
Sole custody to father (provide legal document)
Custody granted to a legal guardian (provide legal document)
Foster care placement (provide legal document)
State Agency Client (provide legal document)
Name & Role of Primary Contact as Parent/Guardian (ie. Mother, Father, Grandparent, etc)
*
Your answer
Cell phone of Primary Contact as Parent/Guardian
*
Your answer
Work phone of Primary Contact as Parent/Guardian
Your answer
Home phone if different from cell of Primary Contact as Parent/Guardian
Your answer
Email of Primary Contact as Parent/Guardian
*
Your answer
Name & Role of Secondary Contact as Parent/Guardian (ie. Mother, Father, Grandparent, etc)
Your answer
Cell phone of Secondary Contact as Parent/Guardian
*
Your answer
Work phone of Secondary Contact as Parent/Guardian
Your answer
Home phone if different from Primary Contact as Parent/Guardian
Your answer
Email of Secondary Contact as Parent/Guardian
Your answer
Mailing address of Secondary Contact as Parent/Guardian if different from Primary Monhegan Address
Your answer
HEALTH: Please check all that apply.
*
My child DOES NOT have any known health issues about which the school should be aware.
My child takes medication at home daily.
My child needs to take medication at school.
My child has a formal 504 Plan in place related to a physical disability.
My child has an Individual Education Plan under the Special Education Laws
Required
HEALTH: If a known disability or health issue exists, please describe and provide the 504, IEP, or Health Action Plan the school will need to follow.
Your answer
HEALTH: IMMUNIZATIONS. In Maine, a child is not legally able to attend school without a complete record (either immunizations or exemptions) .
*
My child is up to date with regular physicals and required immunizations. (Provide a copy of health record)
My child is not immunized due to a Medical Exemption (must provide signed physician's statement)
STUDENT'S GENDER:
*
Born male
Born female
Other: I would like to discuss special circumstances on this issue.
Required
RACE for State/Federal Student Data Reports?
*
Your answer
Name of previous school attended
Your answer
Address of previous school attended
Your answer
Phone number of previous school attended
Your answer
STUDENT'S STRENGTHS/INTERESTS:
Your answer
AREA(S) YOU WANT TO BE STUDENT HAS SUPPORT FOR IMPROVEMENT
Your answer
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