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New Student Enrollment Form SY22
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* Indicates required question
Email
*
Your email
My student(s) will
*
Carpool
Participate in Before and/or After Care
Walk
Ride a van
Be dropped off and picked up by me
PGCPS Student ID #
*
Your answer
Student Last Name
*
Your answer
Student First Name
*
Your answer
Student Middle Name (full middle name)
Your answer
Student Birthdate
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Student Grade for 2021-22 Academic Year
*
Select 6 if your child is in 5th grade now
6
7
8
9
10
11
12
Parent title
*
name of only one parent will be entered; you will be able to enter multiple emails and phone numbers
Mr
Mrs
Ms
Other:
Parent's First Name
*
Your answer
Parent's Last Name:
*
Your answer
Home phone number:
*
Your answer
Cell Phone Number 1:
*
Your answer
Cell Phone Number 2:
Your answer
Work Phone Number:
*
Your answer
Any other phone number:
Your answer
Email address 1(Do not use work email):
*
Your answer
Email address 2:
Your answer
Email address 3:
Your answer
House Number:
*
Your answer
Street Name
*
e.g. Overdale, New Haven, etc
Your answer
Street Tag
*
Road
Way
Lane
Drive
Place
Terr
Street
Ave
Circle
Blvd
Way
Pl
Court
Other:
Unit number:
Your answer
City:
*
Your answer
State:
*
Your answer
Zipcode:
*
Your answer
I give permission CMIT South to send me text alerts/updates. I understand that my cellular phone service provider may charge me for incoming text messages.
*
Yes, I give permission for text messages
No, I do not want to receive text messages
Electronic signature:
*
type your full name as your signature
Your answer
Send me a copy of my responses.
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