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New Student Enrollment Form Middle and High School

Student Enrollment Form - Whitehall, Montana 6-12

Grade Entering (2023-24 School Year)*
Answer Required
Answer Required
Race (check all that apply)*
Answer Required
Does your child have an IEP plan?*
Answer Required
Does your child have a 504 plan?*
Answer Required
Is your child's home language anything other than English?*
Answer Required

Primary Household Information

Answer Required

Mailing Address (if different from physical address)

Answer Required

Parent/Guardian Information

Additional Parent/Guardian Information (if applicable)

Siblings (Only list siblings also attending Whitehall Schools)

Sibling 1

Sibling 2

Sibling 3

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

Answer Required

Emergency Contact Information

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

Emergency Contact 1

Emergency Contact 2

Student Specific Information

Court Protection Order?*
Answer Required
Parenting Plan?*
Answer Required
Medication taken at home?*
Answer Required
Medication taken at school?*
Answer Required
Does your child have any allergies that need to be noted?*
Answer Required
Has this student ever been suspended or expelled from school?*
Answer Required
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

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

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