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BIC ENROLLMENT FORM
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* Indicates required question
Student Name (First, Middle, Last as on birth certificate)
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Your answer
Birthdate
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MM
/
DD
/
YYYY
Gender
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Your answer
Grade
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Choose
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Primary Race
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Primary Language of Student
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Your answer
Student Mailing Address
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Your answer
Student Physical Address
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Your answer
Name of Parent/Guardian
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Your answer
Relationship to student
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Your answer
Parent Contact Telephone
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Your answer
Parent Mailing Address
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Parent Physical Address
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Your answer
Parent Email Address
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Your answer
Parent Employer/Contact Work Phone
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Your answer
Parent Employer/Contact Work Phone
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Your answer
Emergency Contact
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Your answer
Last School Attended/Contact Info. for School
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Your answer
Has this student been expelled/under expulsion from another school district? If so, name of school.
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Has this student been retained? If so, what grade level?
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Does this child has an IEP or 504?
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Does this child have medical concerns? If so, please list.
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If you wish to receive automated school text and voice alerts, please provide us with all cell phone numbers you wish to receive this alert below. If you don't want to receive alerts, please type no.
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