New Student Enrollment Form Elementary

Student Enrollment Form - Whitehall, Montana Elementary

School Transferring From*

Answer Required

Student's Legal First Name*

Answer Required

Student's Legal Middle Name

Answer Required

Student's Legal Last Name*

Answer Required

Student's Preferred Name

Answer Required

Student Cell Phone (if applicable)*

Number Required

Date of Birth*

Answer Required

Place of Birth*

Answer Required

Grade Entering*

Answer Required

Race (check all that apply)*

Answer Required

Asian

Hispanic/Latino

American Indian/Alaska Native

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Other

Is your child's home language anything other than English?*

Answer Required

Yes

If yes, what language did your child learn when they first began to talk?

Answer Required

If yes, what language does your child most frequently speak at home?

Answer Required

Primary Household/Members (Please list only those members living at this address)

Home Phone*

Number Required

Physical Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Mailing Address - if different from physical address.

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Parent/Guardian 1 Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Relationship*

Answer Required

Mobile Phone*

Number Required

Employer

Answer Required

Employer Phone

Number Required

Parent/Guardian 2 Information

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Relationship

Answer Required

Mobile Phone

Number Required

Employer

Answer Required

Employer Phone

Number Required

Siblings

Sibling 1

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Age

Answer Required

Grade

Answer Required

School

Answer Required

Sibling 2

First Name

Answer Required

Middle Name

Answer Required

Age

Answer Required

Grade

Answer Required

School

Answer Required

Sibling 3

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Age

Answer Required

Grade

Answer Required

School

Answer Required

Sibling 4

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Age

Answer Required

Grade

Answer Required

School

Answer Required

Sibling 5

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Age

Answer Required

Grade

Answer Required

School

Answer Required

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

Secondary Household Home Phone (if applicable)

Number Required

Mailing Address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Parent/Guardian 1

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Relationship

Answer Required

Mobile Phone

Number Required

Parent/Guardian 2

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Relationship

Answer Required

Mobile Phone

Number Required

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

Last Name*

Answer Required

Relationship to Student*

Answer Required

Cell Phone*

Number Required

Home Phone*

Number Required

Answer Required

Work Phone

Number Required

Emergency Contact 2

First Name

Answer Required

Last Name

Answer Required

Relationship to Student

Answer Required

Cell Phone

Number Required

Home Phone

Number Required

Answer Required

Work Phone

Number Required

Student Specific Information

Does this student have special needs?*

Answer Required

Yes

If yes, check one:

Answer Required

IEP

504 Plan

LEP

Other

Court Protection Order?*

Answer Required

Yes

If yes, against who?

Answer Required

Parenting Plan?

Answer Required

Yes

Medical Conditions (if applicable)

Answer Required

Medication taken at home?*

Answer Required

Yes

If yes, what and when?

Answer Required

Medication taken at school?*

Answer Required

Yes

If yes, what and when?

Answer Required

Allergies?

Answer Required

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

Answer Required

Yes

If yes, please explain.

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

Yes

If yes, state name and their relationship to student.

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.*

Signature Required

Please fix the highlighted areas below before submitting.

New Student Enrollment Form Elementary