School Enrollment / Residency Form (Page 2 of 2) in pdf

ADDITIONAL CONTACTS - If student is sick & parents are unavailable, who would you allow to pick them up from

school?

____________________________________________________________________________________________

name

relationship to student

home phone

____________________________________________________________________________________________

name

relationship to student

home phone

If there is joint custody and student lives in another household, please complete this next section:

Guardian ____________________________________________________________________________________

Family 2

Last name

First

relationship to student

Address______________________________________________________________________________________

____________________________________________________________________________________________

City

State

Zip

Mailing address (If different)______________________________________________________________________

Home Phone _________________________

Cell______________________________

Employer _______________________________________________ Phone ______________________________

Email Address _____________________________________________________________________________

Spouse ______________________________________________________________________________________

Family 2

Last name

First

relationship to student

Cell ______________________________

Employer _______________________________________________ Phone ______________________________

Can we share student information with everyone listed on this form? ________________________________

RESIDENCY VERIFICATION STATEMENT

According to State Attorney General Opinion No. 5925, school districts have the right to ask new enrollees to prove residency.

By signing this affidavit, you are affirming that the address given on the student enrollment information is the legal residence of

the parent/guardian enrolling the student and is the residence of the student.

Please indicate or explain how you document residency and provide evidence.

Verification may be made with any two of the following: (school personnel will verify and initial which is used)

_____Driver’s license or voter’s registration

_____Purchase agreement / mortgage / renter’s receipt

_____Utility bill

_____Moving bill

_____Property tax bill

_____other (please specify) ______________________________

*Failure to meet the residency requirement will result in the student not being able to attend school until such verification is

received in the school office.

Further, should the school district at any time learn that this is not the actual residence and that the parent and student live

outside the boundaries of the Fremont Public Schools, the student will immediately be dropped from the attendance roster. Also,

should it be determined by the district that there was an attempt on the part of the parent or student to defraud the school district

of entitled tuition, restitution will be sought. In doing so, the district may file charges with appropriate authorities for prosecution

and to recover the lost tuition and resultant legal fees.

BY SIGNING BELOW YOU INDICATE THAT YOU HAVE READ & UNDERSTAND THIS DOCUMENT.

_______________________________________________ ___________________________

____________________

Signature of Parent / Guardian

Date

Staff Initials

Rev 06/07/2011 wji/vv

School Enrollment / Residency Form Page 2

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