School Enrollment Form

This must be completed by Parent/ Legal Guardian

Today's Daterequired

(Must contain a date in M/D/YYYY format)

School to be Enrolledrequired

Grade to Be Enrolledrequired

Student Namerequired

First Name

Middle (optional)

Last Name

Sexrequired

Male

Female

Date of Birthrequired

Home Phone Numberrequired

Physical Addressrequired

Ex. 123 Apple St., Greensboro, AL 36744

Mailing Address (if different than above)

The student lives with...required

Parents

Mother Only

Father Only

Guardian

If you answered Guardian above what is the relation to the student:

Mother/Guardian Name

First Name

Last Name

Email Address

Address

Ex. 123 Apple St., Greensboro, AL 36744

Cell Phone

Employer

Work Phone

Father/Guardian Name

First Name

Last Name

Email Address

Address

Ex. 123 Apple St., Greensboro, AL 36744

Cell Phone

Employer

Work Phone

Special Information About Custody0 / 1000

Emergency Contact #1required

First Name

Last Name

Relationship to Studentrequired

Phone Number (Please Use Numbers Other Than Your Own)

Emergency Contact #2required

First Name

Last Name

Relationship to Studentrequired

Phone Number (Please Use Numbers Other Than Your Own)

The Following People Have Permission to Check My Child Out of School:

(in accordance with school system check-out procedures)

1.

First Name

Last Name

Phone Number

2.

First Name

Last Name

Phone Number

3.

First Name

Last Name

Phone Number

List the Name and Address of Last School Attended:required

What is the student's race and/or ethnicity? SELECT ALL THAT APPLY:requiredPlease select up to 7 choices

AMERICAN INDIAN OR ALASKA NATIVE (Ex. Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.)

ASIAN (Ex. Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.)

BLACK OR AFRICAN AMERICAN (Ex. African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.)

HISPANIC OR LATINO (Ex. Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.)

MIDDLE EASTERN OR NORTH AFRICAN (Ex. Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.)

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER (Ex. Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marsha/Iese, etc.)

WHITE (Ex. English, German, Irish, Italian, Polish, Scottish, etc.)

Please select up to 7 choices

Agreementrequired

I am the student's legal guardian and certify that the information that I have included in this form is correct as of the date completed.

Digital Signature of Person Completing the Formrequired

First Name

Last Name

In This Section

Application for Student Enrollment

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