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Student Registration Form

Student Name: *
Address: *
Date of Birth: *
Sex: *
Enrolling for Grade: *

Transportation Information

In what county do you reside? *

Ethnicity/Race (Federal Requirement)

Part A: Is this student Hispanic/Latino? *
(Defined as a person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.) Choose only one:
Part B: What is the student’s race? *
(Choose one or more, regardless of ethnicity)
Does your child have any special needs?
If “Yes” please supply a copy of the plan

Parent/Guardian Information

Custody papers?
If Yes, Custody papers must be supplied

Emergency Contacts