Sunrise Middle School Enrollment/Registration
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Demographic Information
Student Name (First, middle, and last) *
Student's Address (street Apt. City State and ZIP code) *
Phone (Needs to be answered from 7:30am to 4pm) *
Parent/Guardian's Address (if different from the student's address)
Student's Date of Birth *
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Birth City, State, and Country *
Gender *
Entering Grade Level *
Social Security Number *
Is the student Hispanic or Latino? *
What is your student's race? *
Required
Student District of Residence *
Required
Has the student been enrolled in a school in the U.S. for less than three years? *
Parent/Guardian Information
Legal Guardian #1 *
Relationship to student *
Phone during school hours *
Work phone *
Email *
Legal guardian #2 *
Relationship to the student *
Phone during school hours *
Work phone *
Email *
Mother's highest educational level *
Required
Father's highest educational level *
Required
Custody/Guardian
Do you have a “Caregiver Affidavit”. Form completed?  If there is an agreement of legal custody regarding the student, please select: (If student is not to be released to both parents, a copy of the custody papers must be on file at the school.)
Emergency Contacts
Emergency contact #1 Full name *
Emergency contact #1 Phone number *
Emergency contact #1 Relationship *
Emergency contact #2 Full name *
Emergency contact #2 Phone number *
Emergency contact #2 Relationship *
Emergency contact #3Full name *
Emergency contact #3 Phone number *
Emergency contact #3 Relationship *
Medial Information
Medical insurance name *
Group/Id number *
Doctor full name *
Phone number *
Dentist full name *
Phone number *
Does your student have any allergies? *
If yes, please provide the type of allergy that your student has and provide the specific actions that need to be taken if your student suffers an allergic reaction:
Does your student have any other health problems of which the school should be aware of? *
If yes, please describe:
Does your student wear glasses or contacts? *
If yes, only in the classroom or all day?
Clear selection
If activities should be limited in any way, please explain:
Please indicate if your child has had any of the following conditions: *
Required
Is your child on a medication regimen? If YES and medication needs to be administered during schools hours, then Sunrise Middle School will require a doctor’s note. *
If YES, what is the condition?
If YES, what is the dosage?
If YES, what is the medication?
If YES, what is the physician's name?
If YES, what is the physician's phone?
Is your student allergic to any medications?
Clear selection
If yes, please list medicine(s) and type of reaction:
Does your student take any medication (either over-the-counter or prescription) on a regular basis? *
If yes, please list:
Special Education Inquiry Form
Does your child have an IEP (Individualized Education Program)? *
Does your child have a 504 Plan? *
Does your child have a Psychological Report? *
Does your child have a Speech Report? *
Has your child been enrolled in Special Day Class? *
Has your child been enrolled in a Resource Specialist Program (RSP)? *
Has your child been identified as needing any other special education services not listed above? *
If yes, please explain
If you answered YES to any of the questions listed above, please provide the name of the school and your student’s grade when your student receive his/her most recent IEP, 504 Plan, Psychological Report, or Speech Report, or the name of the most recent school where your student was enrolled in Special Day Class, RSP, or any other special education services.
Name of former school
Grade level
Former school address (street city State, Zip code)
Former school phone
Former school fax
Student name
Date of birth
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