Re-enrollment form 2023-2024
Please fill out all required fields to re-enroll your child for the 2021-2022 school year
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Email *
Student Last Name *
Student First Name *
Student Middle Name
Current Age
Date of Birth *
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Gender
Has the student been expelled or is currently pending expulsion? *
Required
Last School Attended
Last Date of Attendance
Is Ethnicity Hispanic or Latino
This information is for reporting demographic data when applicable. Completion is not a condition of enrollment.
Race:
This information is for reporting demographic data when applicable. Completion is not a condition of enrollment.
Special Classes, Accommodations or Services (Check all that apply)
This information is for continuation of services. Completion is not a condition of enrollment.
What language do people speak in the home most of the time?
This information is for continuation of services. Completion is not a condition of enrollment.
What language does the student speak most of the time?
This information is for continuation of services. Completion is not a condition of enrollment.
What language did the student first speak or understand?
This information is for continuation of services. Completion is not a condition of enrollment.
Primary Contact (Parent/Guardian) Last Name:
Primary Contact (Parent/Guardian) First Name:
Primary Contact Relation to student:
Mailing Address
Apartment Number
City
State
Zip Code
Occupation
Home Phone Number
Cell Phone Number
Work Phone Number
Email Address
Military:
Start date of Military Service
Does the student live with this contact?
Does this contact have legal custody?
OK for this contact to pick up student?
OK to receive confidential school information in the mail (report cards, behavior intervention information, etc...)?
Secondary Contact Last Name:
Secondary Contact First Name:
Secondary Contact Relation to student:
Mailing Address
If same as primary contact put "SAME" and skip to Occupation
Apartment Number
City
State
Zip Code
Secondary Contact Occupation
Secondary Contact Home Phone Number
Secondary Contact Cell Phone Number
Secondary Contact Work Phone Number
Secondary Contact Email Address
Military:
Start date of Military Service
Does the student live with this contact?
Does this contact have legal custody?
OK for this contact to pick up student?
OK to receive confidential school information in the mail (report cards, behavior intervention information, etc...)?
I give my permission for my child's picture to be used anytime by Las Puertas Community School / StrengthBuilding Partners for the purpose of recruiting and/or public relations.
Please type your name as an electronic signature to affirm that the above information is true and correct to the best of your knowledge? *
Type your name here and input the date on the next question to acknowledge the above affirmation with your digital signature
Today's Date *
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