ECMS-G 21-22 - Re-Enrollment Form (English)

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Parent/Guardian email address is needed

Email *

Student Information

Student's Last Name *

Student's First Name *

Student's Middle Name

Date of Birth *

YYYY

What grade is the student entering in Fall 2021? *

7th

8th

Have you recently moved or changed your address or contact information

Yes

Clear selection

If "Yes" what is your new address and street

Apt #

City and Zip Code

Mother/Guardian First Name

Mother/Guardian Last Name

Address (if different from the student's)

Apartment #

City

State

Other:

Clear selection

ZIP Code

Mobile Phone #

Home Phone #

Name of Employer (optiona)

Employer Phone #

First Name of Father / Guardian

Last Name of Father/Guardian

Father/Guardian Home Address (if different than student)

City

State

Zip Code

Father/Guardian Home Phone #

Father/Guardian Mobile #

Father/Guardian Email Address

Father/Guardian Employer

Father/Guardian Work Phone #

Who does the student reside with? *

Mother/Guardian

Father/Guardian

Both parents/guardian

None of the above

Other

If the student does not reside with either parent/guardian, please provide information about the adult the student resides with.

Adult's Last Name

Adult's First Name

Adult's Home Phone #

Adult's Cell Phone #

Adult's Email Address

Is there anyone who the child may not legally be released to?

Yes - Please provide court documentation to ECS before the start of the school year.

Clear selection

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