ENROLLMENT CHECKLIST
Please keep copies of all Forms needed for Registering a student in a handy FILE in your
office, as well as your briefcase or “road supplies” if you register students outside of your
office. All forms must be filled out in BLUE INK.
ENROLLMENT APPLICATION- (a one page form)
1. Check if student is New, Continuously Enrolled, or Previously Dropped
2. If Previously Dropped, please list Drop date
3. We need the student’s Legal name, per Official Birth Certificate. If they go by
another name, it should be listed under “nickname, or alias”, and/or “maiden
name” if applicable.
4. List LAST name first. Then first, then middle.
5. Place of birth should be Town and State. (not county)
6. School District of Residence is usually known by the family, or more easily
guessed by them, than it is by us. Please don’t skip over this, we need the info.
7. County of Residence, (not country)
8. Parent/Guardian Info: If Adult Student, please write Adult in this area
9. Relationship to student: If the person enrolling student is not listed on the Official
Birth Certificate, we need a Caregiver Affidavit filled out, or, a Legal guardian
paper. (hand written notes are no longer accepted). Please renew each year!
10. If parent/guardian has same address, please list “same as student” (not left blank)
11. Previous School Information: This is needed to get the student’s records. (not
parent’s education) Please be sure this is accurate and completely filled in and
legible. List most recent first.
12. Be certain the box is Parent-initialed in regard to Private School Enrollment
13. Special Education: If a student has an IEP, be sure to contact Special Ed Dept. for
enrollment approval, before student begins any school attendance. (They will
need to see copy of the current, or most recent, IEP.)
14. Double check that ALL items from top to bottom of Form are filled in. People
frequently skip over areas they feel don’t matter, or they don’t notice. Each
question is related to something we need to know for one required report or
another, tied to school funding
15. First Date of Attendance (for the current school year) should be the first day the
student is doing school work. Remember this date should not be before
Enrollment Approval if student has Special Education, or if there are any
Expulsion, Suspension, Truancy, or other unusual circumstances needing
Administrative pre-approval.
16. Signature of parent/guardian, and Teacher are all required. (Please remember to
print the names as well).
17. Signature dates are critical. They must be on, or before the first date of attendance
listed. Each person should date their own signature.
Updated 1-13-14
STUDENT AGREEMENT (two page form)
1. Use BLUE ink
2. Keep page one and two together at all times. (Best thing- print double sided)
3. List LAST name first, then first. This small detail saves gobs of time !!!
4. Double check that each blank is completely filled in.
5. Be certain both boxes on page 2 are initialed, in BLUE ink.
6. Student, Parent/Guardian, and Teacher signatures are all required (ALL age students)
7. Signature dates are critical, and must be on, or before, the first date of attendance on
the Enrollment Form, Learning Record and Attendance Log.
8. Remember, Student Agreements do NOT come in with the other enrollment papers.
Elementary go directly to LR Checker @ Admin Office.
High School to Counselor @ Admin Office.
9. High School TRANSCRIPT needs to be included with H.S. Student Agreement
STUDENT EMERGENCY AND IDENTIFICATION INFORMATION
Please be sure this is complete and accurate for emergency use. (It may be printed on
back side of Enrollment Form. Do not print on back of any other form please).
HOME LANGUAGE FORM
Please be sure this is completed for our required language reports and testing. Only
needs to be submitted ONE time. (not every year).
PARENT SURVEY
Critical for determining what public grants and funds our school qualifies for.
BIRTH CERTIFICATE
1. Must be Official Birth Certificate from County or State, or Country. The auditor
does not accept Hospital or Clinic Birth Records, even if they say the word
“certificate” on them. They do not have the official detailed info the Official Birth
Certificate has.
IMMUNIZATION RECORDS, or WAIVER (NEW 1 pg. Form, for ALL shots/All grades)
1-Always check to be sure any shot records have the Minimum required shots: 5 DPT
shots, 4 Polio Shots, 3 Hep. B shots, 2 MMR shots, 1 Varicella shot (or the diseaseChickenpox). Additional, for Gr.7-12- the Tdap shot
2-All New Out of State students, All New KN students, and all New Gr.7 students,
MUST use NEW FORM to waiver any/all shots.(“Personal Beliefs Exemption to
Required Immunizations”)
3-Additionally, anyone in other grades, who needs to waiver any/all shots, that does not
*already have* a waiver from previous CA school, must use the New Form.
4- Parents must get health practitioner signature on the Waiver for Shots, on, or before,
first date of attendance. This is required in ALL California schools since Jan.1, 2014.
5- Parents using the New Immunization Waiver must sign the Waiver in two places, on
part B. of waiver form. Signature dates must be on, or before, the first date of attendance.
Updated 1-13-14
ORAL HEALTH ASSESSMENT/WAIVER REQUEST FORM (now a ONE page form)
1. Parent fills in top of form with student information
2. If assessed by Dentist, the Dental Office fills in part two (middle of the page).
3. For WAIVER of this assessment, Parent fills in and signs the bottom section.
4. This is for ALL KN and 1st graders, and is a California State Form.
PHYSICAL HEALTH EXAM, or WAIVER (two separate forms)
1. This is required for all 1st through 4th grade students, and is California State form.
2. The form for Physical Health Exam is called “Report of Health Examination for
School Entry”, and is meant to be filled out by the Physician. Most doctor offices
and clinics have this form. But you can provide it to parent if needed.
3. The Waiver for the Physical Health Exam is called “Waiver for Health
Examination for School Entry”. They are two different forms. And the Waiver for
the Physical should not be confused with the Waiver for Immunization.
4. The “CDHP” Health Exam is the only other acceptable form for this requirement
CAREGIVER’S AUTHORIZATION AFFIDAVIT (1 pg. form + parent info page)
1. This form is required for ALL students being enrolled by anyone who is not listed
on the Official Birth Certificate. It is to be filled out by the person enrolling the
student, giving their own name, home address, date of birth and driver’s license or
I.D. card number. As well as the student’s name and date of birth. Then check the
appropriate choice as to if the legal parent(s) is advised or not, on #6.
2. The Form must be signed and dated by the person enrolling the student.
(Caregiver)
3. Page 2 of this form is NOTICES and anyone filling it out should be given copy to
read. (This is State of CA. form)
4. In the past I have said only to send new ones, if there is a change in Caregiver.
Now we know it is required to be sent in yearly, in Fall. So please renew when
you do your enrollment forms for Fall.
Updated 1-13-14