2022-2023 DeKalb Transfer Student Information
Parents please complete and submit the information below for each rising 6th, 7th, and 8th grade student enrolling at Chamblee Middle School from another DeKalb County School. We will use this information to update our system for the 22-23 school year. Current Chamblee Middle students have a separate form and should not complete this form. New students to DeKalb should not complete this form. Rising students from Ashford Park, Huntley Hills, Kittredge Magnet, and Montgomery should not complete this form.
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Student's Last Name *
Student's First Name *
Student's Middle Name *
Student's Grade Level for 2021-2022: *
Student's Birth Date (MM-DD-YYYY) *
MM
/
DD
/
YYYY
Last School Student Attended *
Parent #1 Last Name *
Parent #1 First Name *
Parent #1 Relationship to Student: *
Parent #1 Email *
Parent #1 Phone Number *
This is the primary contact number for parent #1. If this number is unavailable, the school will use the additional number(s) below.
Parent #1 Additional Number
Parent #1 Additional Number
Parent #1 Address (Street,City, State, Zip) *
Parent #1 Address: *
Parent #1 Address: *
Parent #2 Last Name
Parent #2 First Name
Parent #2 Relationship to Student:
Parent #2 Email
Parent #2 Phone Number
This is the primary contact number for parent #2. If this number is unavailable, the school will use the additional number(s) below.
Parent #2 Additional Number
Parent #2 Additional Number
Parent #2 Address: *
Parent #2 Address: *
Parent #2 Address: *
Student lives with: *
Parent #2 Address (Street,City, State, Zip)
Emergency Contact #1 Last Name *
Emergency Contact #1 First Name *
Emergency Contact #1 Relationship to Student: *
Emergency Contact #1 Phone Number *
Emergency Contact #1: *
Emergency Contact #2 Last Name
Emergency Contact #2 First Name
Emergency Contact #2 Relationship to Student:
Emergency Contact #2 Phone Number
Emergency Contact #2:
Emergency Contact #3 Last Name
Emergency Contact #3 First Name
Emergency Contact #3 Relationship to Student:
Emergency Contact #3 Phone Number
Emergency Contact #3:
Emergency Contact #4 Last Name
Emergency Contact #4 First Name
Emergency Contact #4 Relationship to Student:
Emergency Contact #4 Phone Number
Emergency Contact #4:
Media Release: *
I [parent name], agree to grant DeKalb County School District and its assigns the right to use photo and/or video images and sound for use in news and/or educational programs in whole or in part for any currently known media or media to be developed.I agree to release the DeKalb County School District from any and all claims, damages, liabilities and costs now or might have regarding my appearance in association with news stories and/or educational programs.I hereby release all rights that I, my heirs, or assigns might have now or in the future to all or part of the said production, including but not limited to, the publishing, printing, development, editing, and use in newspapers and other forms of print and digital media (including social media), broadcasting,cablecasting, webcasting, podcasting, video on demand, or any other public or private presentation or screening purposes by the DeKalb County School District or its assigns.I knowingly and willing waive any and all rights or entitlements, including payments for my appearance or for the subsequent distribution of the products related to this program.
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