ENROLLMENT FORM
Please complete this form to enroll your child in the Daniel J. Bakie Elementary School. Enter information for every required question.  If the answer is not applicable, type NA.
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Email *
Student's First Name *
Student's Middle Name *
Student's Last Name *
Student's Date of Birth (mm/dd/yyyy) *
Student's Gender *
Student's Grade (For the 2020-2021 School Year) *
Student's Primary Street Address *
Student's Primary Town *
Mailing Address (if different from above)
Mother's Full Name *
Mother's Cell or Home Phone *
Mother's Email Address *
Mother's Home Address *
Mother's Work Name & Address *
Mother's Work Phone *
Father's Full Name *
Father's Home Address *
Father's Cell or Home Phone *
Father's Email Address *
Father's Work Name & Address *
Father's Work Phone *
Child resides with *
If Guardian or Other checked above, please specify name of the person the child is living with.
Are there any court ordered restrictions on the release of information or the dismissal of this student to either natural parent?  If yes, please provide us with a copy of the legal document. *
If you answered Yes above, you agree to provide the school with the most up to date copy of the legal document and any updates as they occur in a timely manner.
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Has your child attended Nursery School? *
Enter the Name of the School they attended for Nursery. *
Has your child attended Kindergarten? *
Enter the Name of the  School they attended for Kindergarten.
Enter the Name and Address of the School they most recently attended. *
Enter the From and To Dates the most recently attended on the school above. *
Enter the Name and Address of the School they previously attended.  Enter NA if not applicable. *
Enter the From and To Dates they attended on the school above. Enter NA if not applicable. *
Enter Sibling First and Last Name, Date of Birth, and the School currently attending. *
Enter Sibling First and Last Name, Date of Birth, and the School currently attending.
Enter Sibling First and Last Name, Date of Birth, and the School currently attending.
Please check any special programs your child has received.
Enter Provider of Services Name, Address, Phone, and Contact Person
Please use this space to provide us with comments or special notes.
By printing my name below, I, the parent/guardian, authorize the school enroll my child in the Daniel J. Bakie Elementary School. *
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