2022-2023 Registration
Please complete the following form for all students you need to enroll. If all of your students reside at one primary residence (with the same schedule), you will only need to complete this form one time. If they do not reside at the same primary student residence, please complete multiple forms with the corresponding information for each child. If you have any questions, please contact office@moscowcharterschool.org
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Email *
Student 1-Legal Last Name: *
Student 1-Legal First Name: *
Student 1- Legal Middle Name: *
Student 1-Preferred Name (optional):
Student 1-Gender *
Student 1-Date of Birth *
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Student 1-City, State of Birth *
Student 1-Grade of Enrollment *
Student 1-Did your student attend MCS last year? If no, please list previous school information in other: *
Student 1-Ethnicity *
Student 1-Race (check all that apply) *
Required
Student 1-Is a citizen of the United States?  If no, please tell us their citizenship under other: *
Student 1-Is an Immigrant? If yes, please tell us their immigration entry date and native language under other: *
Student 1-Does the parent/guardian of this student have a military connection? *
Student 1-Does Student have any known allergies? If yes, please list below:
Student 1-Please list any medication your student will need to have available at the school: (please note: you must turn in a PERMISSION TO ADMINISTER MEDICATION form signed by your student's doctor in order for the school to administer medication)
Student 1-Are there any chronic, special conditions or health situations that you would like us to be aware of? Known physical or mental disabilities?
Student 1-In case of emergency, are there any other medications we should know about that your student takes regularly? Please list:
Student 1-Physician's Name *
Student 1-Physician's Phone Number *
Student 1-Insurance Company *
Student 1-Insurance Policy Number *
Student 1-Is your student currently receiving any the following services? (check all that apply)
Student 1-Check any of the following that may affect your student's progress:
Student 1-Will your student ride the bus? *
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