MS Student Enrollment Forms '22

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MS Student Enrollment Forms '22 - '23

Email *

STUDENT'S Last Name *

STUDENT'S First Name *

STUDENT'S Date of Birth *

YYYY

Place of Birth (city & state)

Student's Grade in the '22-'23 school year *

Last School Student Attended (School Name, City, State) *

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. *

African American/Black

American Indian/Alaskan Native

Asian

Caucasian/ White

Hispanic

Native Hawaiian/ Pacific Islander

Required

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.

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