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Pond Creek-Hunter Middle School Online Enrollment Packet
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* Indicates required question
Name of Person Completing Form
*
Your answer
Relationship to Child
*
Mother
Father
Guardian
Grandparent
Aunt or Uncle
Other
Other:
Child Legal First Name
*
Your answer
Child Legal Middle Name
Your answer
Child Legal Last Name
*
Your answer
Child Preferred Name or Nickname
Your answer
SSN
Your answer
Date of Birth
*
(MM/DD/YYYY)
Your answer
Birthplace City State
*
Your answer
Mailing Address
*
Your answer
Home Street Address
*
Your answer
City State Zip
*
Your answer
Gender
*
Male
Female
Ethnic Group
*
White
Black
Hispanic
Asian
Native American
2 or More Races
If 2 or More Races, Please Specify Which Races
Your answer
US Citizen
*
Yes
No
Last School Attended
*
Your answer
Last Grade Completed
*
Choose
4th
5th
6th
7th
Grade Entering
*
Choose
5th
6th
7th
8th
Is a language other than English used in the home?
*
Yes
No
If Yes, what is that language
Your answer
If Yes, is that other language spoken in the home
More often than English
Less often than English
Clear selection
Student resides with
*
Both Parents
Mother
Father
Other:
Are there Legal/Custody Papers pertaining to this child? Please note, the school must have a copy of the court order on file declaring custody arrangement.
*
Yes
No
Guardian 1 First Name
*
Your answer
Guardian 1 Last Name
*
Your answer
Guardian 1 Home Phone Number
*
Your answer
Guardian 1 Cell Phone Number
*
Your answer
Guardian 1 Mailing Address
*
Your answer
Guardian 1 City, State, Zip Code
*
Your answer
Guardian 1 E-Mail Address
*
Your answer
Guardian 1 Place Of Employment
*
Your answer
Guardian 1 Work Phone Number
*
Your answer
Guardian 2 First Name
*
Your answer
Guardian 2 Last Name
*
Your answer
Guardian 2 Home Phone Number
*
Your answer
Guardian 2 Cell Phone Number
*
Your answer
Guardian 2 Mailing Address
*
Your answer
Guardian 2 City, State, Zip
*
Your answer
Guardian 2 E-Mail Address
*
Your answer
Guardian 2 Place Of Employment
*
Your answer
Guardian 2 Work Phone Number
*
Your answer
Emergency Contact 1 (other than Parent/Guardian) First & Last Name
*
Your answer
Emergency Contact 1 Phone Number
*
Your answer
Emergency Contact 1 Relationship to Child
*
Your answer
Emergency Contact 2 (other than Parent/Guardian) First & Last Name
*
Your answer
Emergency Contact 2 Phone Number
Your answer
Emergency Contact 2 Relationship to Child
Your answer
Please list any important medical information and/or food allergies for student. *Note: A doctor's note is required for all food allergies. Please turn in to the appropriate office.
Your answer
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