Milwaukee Seventh-day Adventist School

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Student Registration Application

Date of Application *

YYYY

Campus Applied for: *

North Campus

South Campus

Waukesha Campus

Grade Entering *

Student's full legal name

Student's First Name *

Student's Middle Name

Student's Last Name *

Student's Street Address *

Student's City *

Student's State *

Student's Zip Code *

Child's Home Church *

Not Applicable

LaHayes SDA Spanish Church

Maranatha SDA Spanish Church

Milwaukee Central SDA Church

Milwaukee Central Hispanic SDA Church

Milwaukee SDA Hispanic Church

North Milwaukee Hispanic SDA Church

Northwest SDA Church

Southside Adventist Fellowship

Waukesha SDA Church

Waukesha Hispanic SDA Church

Other:

Denomination

Is your child baptized?

Yes

Clear selection

Year baptized

Student Age by September 1

K4 Must be 4

K5 Must be 5

1st Grade Must be 6

Current age *

Date of Birth *

YYYY

Place of Birth *

Gender *

Female

Male

Ethnicity *

Hispanic/Latino

Non-Hispanic

Required

Race *

American Indian - Alaskan Native

Asian

Black - African American

Native Hawaiin - Pacific Islander

White

Required

Previous School your child attended

School Name

School Address

School Street Address

School City

School State

School Zip Code

School Phone Number

Does your child have Special Education Needs? *

Yes

If yes, please explain Special Education Needs

Does your child have an IEP? *

Yes

Medical Information

Asthma or breathing problems *

Yes

Required

If yes, does he/she use an inhaler?

Yes

Clear selection

Food allergies *

yes

Required

List Allergies

Any other allergies *

Yes

Required

List all other allergies

Does your child use an EPI pen?

Yes

Is your child on medications? *

Yes

Required

If yes, list medications

Does your child have any other health conditions? *

If yes, please explain health conditions

Busing

Available for North and South Campuses only with a monthly charge

How my child will travel to and from school *

Bus

Child will be transported by others

Required

Name of others that will transport my child

Parent/Guardian Information

Child lives with: *

Both Parents

Mother

Father

Guardian

Marital status of parent

Married

Divorced

Single

Deceased

Clear selection

Mail School correspondence to: *

Both parents

Mother

Father

Guardian

Father's legal name:

Father's address if different from mother or child

Father's Street

Father's City

Father's State

Father's Zip Code

Father's E-mail address

Father's Home phone

Father's Cell phone

Father's Work phone

Is father SDA? *

Yes

Required

Mother's legal name

Mother's address if different from father or child

Mother's Street

Mother's City

Mother's State

Mother's Zip Code

Mother's E-mail address

Mother's Home phone

Mother's Cell phone

Mother's Work phone

Is mother SDA? *

Yes

Required

Legal Guardian's name

Relation to student

Guardian's address if different from parent or child

Guardian's Street

Guardian's City

Guardian's State

Guardian's Zip Code

Guardian's E-mail

Guardian's Home phone

Guardian's Cell phone

Guardian's Work phone

Is guardian SDA?

Yes

Clear selection

Other information needed for new students when applying

Original Birth Certificate (Will be returned)

Given to the office

Not yet turned in

A copy of your child's Immunization Records

Given to the office

Not yet turned in

Your child's most recent Assessment Test Results and Report Card

Given to the office

Not yet turned in

A copy of your child's IEP if applicable

Given to the office

Not applicable

By entering my name I certify that I completed this application, and that all information is true and correct.

First and Last name *

Submit

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