SCHOOL DISTRICT OF CRANDON STUDENT ENROLLMENT FORM 2015-2016
ENROLLMENT DATE:
/
/
Teacher: _____________________
A. Student’s Legal Name: ___________________________________________________________________________________________________
Sex:
M F
Last
First
Middle
Birthday (mm/dd/yy) ___________________________ Age: _________________ Grade: _________________________
Soc. Sec. # (optional) _________________________
Race: Federal rules require that registration/enrollment forms must now use a two-part question.
1. Is this student Hispanic or Latino? (Choose only one)
_____ No, not Hispanic or Latino
______ Yes, Hispanic or Latino
2. Is this student: (Choose one or more. You must select at least one.) _____ American Indian or Alaska Native (Tribe __________________________) _______ Asian
( Hispanic students must also choose from this list)
_____ Black or African American
_______ White _____ Native Hawaiian or Other Pacific Islander
If yo
If you wish not to have your child’s picture published in the newspaper or any other form of media.
Sign here ___________________________________________________________________________.
_____
Other Family Members in this household (under the age of 18)
Place of Birth: City _______________
State __________________
County _____________
B.
Father’s Name:
Brothers & Sisters
____________________
____________________
Age
_______
_______
Birth date
____________
____________
________________
________________
_____
_____
__________
_________
Is this student involved in any expulsion process or
behavioral proceeding in another District or School?
____ Yes
___ _ No If yes, where? ___________
_______________________
Work Phone: _________________ Cell Number: ______________
Employer Name: __________________________________
Mother’s Name: _______________________
Work Phone: _________________ Cell Number: ______________
Employer Name: __________________________________
Home Phone Number:
_______________________
Fire Number__________________________________________________________
Mailing Address: ______________________________________________________________
Township ____________________________________________________________
Bussing Address: ______________________________________________________________
Bus Driver ___________________________________________________________
Mother living at home?
Number of Miles from School ____________________________________________
Yes
No
Father living at home?
Yes
No
E. Last School Attended ______________________________________________ City__________________________________ State_____________________________________
F. For emergencies, list name and daytime phone numbers of two people to contact if parents or guardian are not available.
Name #1 _____________________________________________ Relationship _________________________ Phone Numbers _____________________ ______________________
Name #2 _____________________________________________ Relationship _________________________ Phone Numbers _____________________ ______________________
Health factors school should be aware of __________________________________________________________________________________________________________________
Preferred doctor and phone number ______________________________________________________________________________________________________________________
If emergency treatment is required and the parents cannot be reached immediately, may the school authorities use their own judgment in calling the doctor indicated above, or an
alternative doctor? (circle one) Yes No If no, what do parents want done?_____________________________________________________________________________________
Custodial Parent/Legal Guardian signature____________________________________________________________________ Date ____________________________________