Family Registration Form

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FAMILY REGISTRATION
Return this form along with your registration fee to the north office.
New Family
Returning Family
School year applying for: ________
Date form completed: ______
Registration fee total: ______
Will be paid by: ______
Registration fees: Pre-K and Kindergarten $75.00, Grades 1 – 12 $100 (per student)
STUDENT INFORMATION
LAST NAME
FIRST NAME
GENDER
AGE
BIRTHDATE
GRADE
ENTERING
____________________________________
_______________________________
_______
____
________
_____
____________________________________
_______________________________
_______
____
________
_____
____________________________________
_______________________________
_______
____
________
_____
____________________________________
_______________________________
_______
____
________
_____
____________________________________
_______________________________
_______
____
________
_____
Address:
_____________________________________________
City/State/Zip:
_________________________________
MEDICAL
Immunizations – check one of the following:
I will provide current immunization records prior to the first day of school.
I will sign a Religious Exemption form prior to the first day of school (this must be done every school year).
Medical concerns (allergies, conditions, etc.): ___________________________________________________________________
EpiPen, inhaler or special equipment required:
________________________________________________________________
If special equipment is required, a signed Self Administer Medication form must be turned into the office prior to the first day of school.
EMERGENCY
Emergency
___________________________________________________
Cell:
___________________________
contact:
PARENT/GUARDIAN INFORMATION
Mother’s name:
_________________________________
Father’s name:
__________________________________
Cell number:
____________________________________
Cell number:
____________________________________
Home Number:
_________________________________
Home number:
___________________________________
Work number:
__________________________________
Work number:
___________________________________
Email:
_________________________________________
Email:
__________________________________________
Address:
______________________________________
Address:
________________________________________
(If different
(If different
______________________________________
________________________________________
than above)
than above)
Occupation and Employer: ___________________________
Occupation and Employer: ___________________________
_________________________________________________
__________________________________________________
(if applicable)
(if applicable)
Step Mother’s
______________________________
_____________________________
Step Father’s name:
name:
Cell number:
____________________________________
Cell number:
____________________________________

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