Review the below information and answer the required question regarding changes at the bottom.

Student Information

Student Name:

Gender:

Date of Birth:

Enrolling Grade:

Enrolling School:

Student's Social Security Number:

Physical Address: ,

Mailing Address: ,

Student's Home Phone:

Is your student military dependent?:

Branch:

Is this student a twin (or triplet, quadruplet etc.)?

What method is the student using to come to school?

Is the student unmarried or legally separated from a spouse and has a child/children that the student has custody/joint custody of or is pregnant?:

Does the student have internet access at home?:

If student does not have internet access at home, please indicate the reason.:

Please indicate the type of internet serviced used in the student’s home.:

Indicate the reliability of the internet service the student has available to them at home.:

Does the student have access to a learning device (computer, laptop, tablet, etc.)?:

Please indicate the type of device the student would use to access lessons online.:

Would the learning device (computer, laptop, tablet, etc.) be a shared with other individuals?:

Parents/Legal Guardians

Parent/Guardian 1

Name:

Relationship to Student:

Employer:

Email:

Lives with student?:

Address: ,

Home/Primary Phone Number:

Phone Number: Phone Type:

Parent/Guardian 2

Name:

Relationship to Student:

Employer:

Email:

Lives with student?:

Address: ,

Home/Primary Phone Number:

Phone Number: Phone Type:

Parent/Guardian 3

Name:

Relationship to Student:

Employer:

Email:

Lives with student?:

Address: ,

Home/Primary Phone Number:

Phone Number: Phone Type:

Parent/Guardian 4

Name:

Relationship to Student:

Employer:

Email:

Lives with student?:

Address: ,

Home/Primary Phone Number:

Phone Number: Phone Type:

Emergency Contacts

Emergency Contact 1

Name:

Relationship to Student:

Home/Primary Phone Number:

Phone Number: Phone Type:

Emergency Contact 2

Name:

Relationship to Student:

Home/Primary Phone Number:

Phone Number: Phone Type:

Emergency Contact 3

Name:

Relationship to Student:

Home/Primary Phone Number:

Phone Number: Phone Type:

Emergency Contact 4

Name:

Relationship to Student:

Home/Primary Phone Number:

Phone Number: Phone Type:

Medical

Doctor Name: Doctor Phone:

Does your child have any medical alerts that the district should be made aware of?: No

Medical Alert 1: Description:

Medical Alert 2: Description:

Medical Alert 3: Description:

Medical Alert 4: Description:

Medical Alert 5: Description:

Medical Alert 6: Description:

Medical Alert 7: Description:

Medical Alert 8: Description:

Medical Alert 9: Description:

Medical Alert 10: Description:

Information Updates

Do you need to change any of the above information?

Please select:required

You are missing required student information. You must say Yes to above to make those updates in order to submit the form.

You have a guardian contact that is missing a required piece of information. You must say Yes to above to make those updates in order to submit the form.

You have an emergency contact that is missing a required piece of information. You must say Yes to above to make those updates in order to submit the form.

Returning Student Registration 2025-2026

Student Information

Parents/Legal Guardians

Parent/Guardian 1

Parent/Guardian 2

Parent/Guardian 3

Parent/Guardian 4

Emergency Contacts

Emergency Contact 1

Emergency Contact 2

Emergency Contact 3

Emergency Contact 4

Medical

Information Updates

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