School Registration Form printable pdf download

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Child’s Legal Name: ___________________________ __________________________ ____________________ Gender: ______

Legal Family Name

Legal First Name

Legal Middle Name

Child’s Usual Name

: ________________________________

_______________________________

________________________

(if different from above)

Usual Family Name

Usual First Name

Usual Middle Name

Address: ____________________________________________ _________________________________ ____________________

Street

City

Postal Code

Phone: _______________________ Cell Phone: _______________________ Email: _____________________________________

Date of Birth: Year: _______ Month: _______ Day: ____ Birthplace: __________________ Citizenship: ______________________

Primary language spoken: ______________________

Child’s Healthcare #: ______________________________________

Please check if more information regarding child’s health is on the back of this form:

Requested Date of Admission: ___________ Grade applying for: ____ School last attended

_______________________

(if applicable )_

FAMILY & CHURCH BACKGROUND

Father’s name: ________________________

Occupation: ____________________ Business phone: ___________________

Mother’s name: ________________________

Occupation: ____________________ Business phone: ___________________

Father’s home address

_________________________________________________________________________

)

(if different from above

Mother’s home address

_________________________________________________________________________

(if different from above)

Siblings not attending Hope Lutheran School under the age of 16, names & birth dates:

___________________________________________________________________________________________________________

Name of church family attends: __________________________________________

Not attending any church at present:

Emergency contact person(s) permitted to pick up student if parents cannot be reached:

1. Name:

___________________________________

2. Name:

______________________________________

Phone:

___________________________________

Phone:

______________________________________

Address: ___________________________________

Address: ______________________________________

___________________________________

______________________________________

Relationship to student: __________________________

Relationship to student: _______________________

Name of Family Doctor: _____________________________________

Phone: _____________________________________

Name of Family Dentist: _____________________________________

Phone: _____________________________________

Signature of Parent/Guardian _________________________________

Date: _______________________________________

I (we) h ear d ab ou t H op e L u th er an Ch r i sti an S ch ool th r ou g h :

______________________

Fr i en d / F ami l y M em b er

Newsp ap er / M ag az i n e

I n ter n et

Oth er (p l ease sp eci fy ):

A ll i n fo rma ti on p ro vi d ed a bo ve i s s t ri c t ly fo r

A ll i n fo rma ti on p ro vi d ed a bo ve i s s t ri c t ly fo r t h e us e o f H op e L u th e ran

t h e us e o f H op e L u th e ran C h ris t ia n

C h ris t ia n Sc h oo l

Sc h oo l

A ll i n fo rma ti on p ro vi d ed a bo ve i s s t ri c t ly fo r

t h e us e o f H op e L u th e ran

C h ris t ia n

Sc h oo l

Signature of this document implies compliance with school policies (as printed in parent handbook) including payment of applicable fees

O f f i c e

U s e

O n l y

Birth Certificate

, or Immigration Document

Registration Fee:

Date Received:

Administration Fee:

Date Received:

Immunization Record

Legal Residency Form,

Admission Interview Date:

Accepted:

yes

with Attachments

School Registration Form

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