New Student Enrollment Form Middle and High School

Student Enrollment Form - Whitehall, Montana 6-12

Student's Legal First Name*

Answer required for "Student's Legal First Name"

Student's Legal Middle Name

Answer required for "Student's Legal Middle Name"

Student's Legal Last Name*

Answer required for "Student's Legal Last Name"

Student's Preferred Name

Answer required for "Student's Preferred Name"

Date of Birth*

Answer required for "Date of Birth"

Place of Birth

Answer required for "Place of Birth"

Student Cell Phone (if applicable)

Number Required

Previous School Name*

Answer required for "Previous School Name"

Previous School City & State*

Answer required for "Previous School City & State"

Previous School Phone #*

Answer required for "Previous School Phone #"

Previous School Fax #

You may need to call your child's previous school for their fax #

Answer required for "Previous School Fax #"

Student's Race (check all that apply)*

Answer required for "Student's Race (check all that apply)"

Asian

Hispanic/Latino

American Indian/Alaska Native

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Other

Is your child's first-learned or home language anything other than English?*

Answer required for "Is your child's first-learned or home language anything other than English?"

Yes

Does your child understand or communicate with anyone in the home using a language other than English?*

Answer required for "Does your child understand or communicate with anyone in the home using a language other than English?"

Yes

Does your child read and/or write in a language other than English?*

Answer required for "Does your child read and/or write in a language other than English?"

Yes

Does your child have exposure to a heritage or ancestral language other than English spoken by family, friends, or community members?*

Answer required for "Does your child have exposure to a heritage or ancestral language other than English spoken by family, friends, or community members?"

Yes

If you answered "Yes" to any of the questions above, please indicate which language(s) other than English does your child hear or use at home?

Answer required for "If you answered \"Yes\" to any of the questions above, please indicate which language(s) other than English does your child hear or use at home?"

If you answered YES to any of the above questions, what language(s) other than English is your child exposed to in their home or community?

Answer required for "If you answered YES to any of the above questions, what language(s) other than English is your child exposed to in their home or community?"

If available, in what language would you prefer to receive communication from the school?

Answer required for "If available, in what language would you prefer to receive communication from the school?"

Primary Household Information

Primary Home Phone*

Number Required

Physical Street Address*

Answer required for "Physical Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Mailing Address (if different from physical address)

PO BOX

Answer required for "PO BOX"

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Parent/Guardian Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Relationship*

Answer required for "Relationship"

Email*

Answer required for "Email"

Mobile Phone*

Number Required

Employer

Answer required for "Employer"

Employer Phone

Number Required

Additional Parent/Guardian Information (if applicable)

First Name

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name

Answer required for "Last Name"

Relationship

Answer required for "Relationship"

Answer required for "Email"

Mobile Phone

Number Required

Employer

Answer required for "Employer"

Employer Phone

Number Required

Siblings attending Whitehall Schools

Sibling 1

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Grade

Answer required for "Grade"

Sibling 2

First Name

Answer required for "First Name"

Grade

Answer required for "Grade"

Additional siblings? List below.

Answer required for "Additional siblings? List below."

Secondary Household/Members (Parent/Guardian NOT living in Primary Household)

Parent/Guardian Name

Answer required for "Parent/Guardian Name"

Relationship to Student?

Answer required for "Relationship to Student?"

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Emergency Contact Information

May be contacted in case of illness or emergency and must be able to pick up student.

Emergency Contact 1

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Relationship to Student*

Answer required for "Relationship to Student"

Cell Phone*

Number Required

Home Phone*

Number Required

Answer required for "Email"

Work Phone

Number Required

Emergency Contact 2

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Relationship to Student

Answer required for "Relationship to Student"

Cell Phone

Number Required

Home Phone

Number Required

Answer required for "Email"

Work Phone

Number Required

Student Specific Information

Does your child have an IEP plan?*

Answer required for "Does your child have an IEP plan?"

Yes

Does your child have a 504 plan?*

Answer required for "Does your child have a 504 plan?"

Yes

Court Protection Order?*

Answer required for "Court Protection Order?"

Yes

If yes, against who?

Answer required for "If yes, against who?"

Parenting Plan?*

Answer required for "Parenting Plan?"

Yes

Medical Conditions (if applicable)

Answer required for "Medical Conditions (if applicable)"

Medication taken at home?*

Answer required for "Medication taken at home?"

Yes

If yes, what and when?

Answer required for "If yes, what and when?"

Medication taken at school?*

Answer required for "Medication taken at school?"

Yes

If yes, what and when?

Answer required for "If yes, what and when?"

Does your child have any allergies that need to be noted?*

Answer required for "Does your child have any allergies that need to be noted?"

Yes

If yes, please list and describe allergies.

Answer required for "If yes, please list and describe allergies."

Has this student ever been suspended or expelled from school?*

Answer required for "Has this student ever been suspended or expelled from school?"

Yes

If yes, please explain.

Answer required for "If yes, please explain."

Is any individual named on this enrollment form (including parent, guardian, sibling, caretaker relative, emergency contact) currently or formerly a registered sex or violent offender?*

Answer required for "Is any individual named on this enrollment form (including parent, guardian, sibling, caretaker relative, emergency contact) currently or formerly a registered sex or violent offender?"

Yes

If yes, state name and their relationship to student.

Answer required for "If yes, state name and their relationship to student."

Current or former individuals on the Sex/Violent Offender Reqistry are NOT permitted on school property or have limited access per District Policy #4015

I certify that I am the legal guardian of the child and that all information provided is true and accurate to the best of my knowledge. I verify that I reside within the school district boundaries or have an approved non-resident status for my child. If I do not reside within district boundaries, I will complete the required out-of-district paperwork and submit it to the school office within five (5) business days. My electronic signature also grants permission to request school records from any previous school my child has attended.*

Signature Required

Please fix the highlighted areas below before submitting.

New Student Enrollment Form Middle and High School