ECPS Required *MS Student Info. Forms '20 - '21
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电子邮件地址 *
 STUDENT'S Last Name *
STUDENT'S First Name *
Student's Grade in the '20-'21 school year *
Last School Student Attended (School Name, City, State) *
STUDENT'S Date of Birth *
年
/
月
/
日
STUDENT's Social Security Number
Primary (1st) Parent or Guardian's Name *
Primary (1st) parent or guardian's relationship to the child: *
Primary (1st) Parent or Guardian Phone Number: *
Primary (1st) Parent or Guardian Email Address:
2nd Parent or Guardian's Name:
2nd parent or guardian's relationship to the child:
2nd Parent or Guardian Phone Number:
2nd Parent or Guardian Email:
3rd Contact for Emergency or Pick Up - Name:
3rd Contact for Emergency or pick up -  relationship to the student:
3rd Contact for Emergency or Pick Up - Phone Number:
4th Contact (optional) for Emergency or Pick Up - Name & Relationship:
4th Contact (optional) for Emergency or pick up -  relationship to the child:
4th Contact (optional) for Emergency or Pick Up - Phone Number:
Any special instructions we need to be aware of regarding pick-up of your child?
Any special instructions we need to be aware of regarding your child's health? (conditions, allergies, regular medications)
STUDENT'S physical address: *
Student's Mailing address (if different): *
City: *
Zip Code: *
Transfer Information: Do you and your child live in the Elmore City-Pernell School District? *
Do you plan on moving within the school year?
Select one or more of the following races. *
必填
Does your student have a tribal citizenship card? (If yes, please present this card to the school office.)
Does your child have and IEP (Individualized Education Plan)?
1st ELECTIVE COURSE: Please select your top (1st) choice. Understand, you may not get all of your choices but we will try our best to accommodate you. *
2nd ELECTIVE COURSE: Please select your 2nd  choice.  Understand, you may not get all of your choices but we will try our best to accommodate you. Do not select a previously chosen elective.
3rd ELECTIVE COURSE: Please select your 3rd  choice.  Understand, you may not get all of your choices but we will try our best to accommodate you. Do not select a previously chosen elective.
ELECTIVE COURSES. Please select your 4th choice. Understand, you may not get all of your choices but we will try our best to accommodate you. Do not select a previously chosen elective.
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