Student Registration Forms Step 1 of 2 50% Student Registration FormsStudent Name* First Name Middle Name Last Name Date of Birth (MM/DD/YYYY)* Date Format: MM slash DD slash YYYY Gender*MaleFemaleRace*Age as of today*City & State of Birth*Address Street Address City State / Province / Region ZIP / Postal Code Student resides with:*Both ParentsMotherFatherStudent’s Address Same as home address Street Address City State / Province / Region ZIP / Postal Code Public School DistrictPublic School your child would be assigned toAre there legal custody issues that the school should be made aware of?YesNoIf yes, please explainDoes your child require an Individualized Educational Plan (IEP)?YesNoIf yes, please attach a copy of the IEP report. Drop files here or Birth Certificate is attached:YesNoBirth Certificate Drop files here or Request for Records is attached:YesNoRequest for Records Drop files here or Consent I verify that all the information on this form is accurate and true to the best of my knowledge.Parent/Guardian’s SignatureDate Date Format: MM slash DD slash YYYY Student Registration--Parent/Guardian InformationParent/Guardian #1 Name* First Name Last Name Relationship to child*Cell Phone #*Parent Email* Address* Street Address City State / Province / Region ZIP / Postal Code Occupation*Company*Work Phone #*Parent/Guardian #2 Name First Name Last Name Relationship to childCell Phone #Parent Email Address Street Address City State / Province / Region ZIP / Postal Code OccupationCompanyWork Phone #Consent I verify that all the information on this form is accurate and true to the best of my knowledge.Parent/Guardian’s SignatureDate Date Format: MM slash DD slash YYYY
