Grant Public Schools Enrollment Form & Emergency Medical Form printable pdf download

Grant Public Schools Enrollment Form

& Emergency Medical Form

__________________________________________________________________

_______________________

Legal Last Name of Student

First Name

Middle Name

Male/Female

__________________________

_______________________________

____________

______________________________

Date of Birth

Twin/Triplet/Etc. & Birth Order

Grade

Phone Number

(ex. 111-111-1111)

_________________________________________________

_____________________________

_______________________

Street Address

City

Zip Code

________________________________________________________________ _________________________

Email Address

Student Cell Phone Number

Is your phone number unlisted? Yes or No

Health Alert? Yes or No, if yes _________________________

Birth Place: ___________________ Original Enrollment Date: _______________ Transfer From: _____________

Grant Public Schools is collecting information regarding the language background of each of its students. This

information will be used by the district to determine the number of students who should be provided bilingual

instruction according to Sections 380.1151 – 380.1155 of School Code of 1995, Michigan’s Bilingual Education

Law.

Home Language Survey:

Is your child’s native tongue a language other than English? Yes _____ No _____

If yes, what is that language? _________________________________________________________________

Is there a language other than English spoken regularly in the home environment? Yes _____ No _____

If yes, what is that language? _________________________________________________________________

Primary Language means “the dominant language used by a person for communication.”

Ethnicity:

______ No, not Hispanic/Latino

______ Yes, Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American or other

Spanish culture or origin, regardless of race.)

Race:

American Indian/Alaskan Native _____

Asian American _____

Native Hawaiian/Pacific Islander _____

Black/African American _____

Caucasian/White _____

Parent/Guardian:

Father/Male Guardian:_________________________ Mother/Female Guardian:__________________________

Relationship to Child:

Biological Father

Step-Father

Other________

Biological Mother

Step-Mother

Other_________

Address: ____________________________________ Address: _______________________________________

Employed At:________________________________ Employed At:____________________________________

Phone Number:_______________________________ Business Phone:__________________________________

Hours At Work:_______________________________ Hours At Work:__________________________________

Email Address: _______________________________ Email Address: __________________________________

Marital Status: _______________________________ Marital Status: ___________________________________

Step Parent: _________________________________ Step Parent: _____________________________________

Whom Child Resides With: _____________________ Whom Child Resides With: ________________________

Grant Public Schools Enrollment Form & Emergency Medical Form

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