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MVCSD OPEN ENROLLMENT
Student's Information
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Initial
*
Your answer
Last Name
*
Your answer
Current Grade
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Home Phone Number
*
Your answer
Work Phone Number
Your answer
Message Phone Number
*
Your answer
Parent's Name
*
Your answer
Home Address (Street, City, Zip) **P.O. Box is not acceptable as an address**
*
Your answer
Home Address (Street, City, Zip)
*
Your answer
Will you be using Mesa Vista Bus Transportation?
*
Yes
No
Please enter 3 Emergency Contacts
1st Emergency Contact Name
*
Your answer
1st Emergency Phone Number
*
Your answer
1st Emergency Contact Relationship
*
Your answer
2nd Emergency Contact Name
*
Your answer
2nd Emergency Phone Number
*
Your answer
2nd Emergency Contact Relationship
*
Your answer
3rd Emergency Contact Name
*
Your answer
3rd Emergency Phone Number
*
Your answer
3rd Emergency Contact Relationship
*
Your answer
Please List any Allergies or Medical Conditions
*
Your answer
The above-name student:
*
resides outside the School District but within NM; or
resides within the School District
Required
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