Student R egistration a nd D irectory R elease F orm
School O ffice U se O nly
Student I D N umber_________________ G rade________ E ntry D ate____/_____/_____ B us N umber _ ________
Parents/Guardians: P lease f ill o ut b oth s ides o f t his r egistration f orm f or y our s tudent. P lease p rint n eatly.
STUDENT I NFORMATION
Student’s L egal N ame:
Last _ ____________________________ F irst _ ____________________________ M iddle________________________
Date o f b irth _ ____/______/______ S ex _ _______ ( M o r F ) S ocial S ecurity N umber _ ______-‐_______-‐_________
Student’s A ddress _ _____________________________________________ A pt. _ _______ _ Z ip C ode _ _____________
Ethnicity:
____ A m. I nd./Alaskan N ative
History:
Has t he s tudent e ver a ttended s chool i n L ouisiana? _ ____ ( Y/N)
Has t he s tudent e ver a ttended a n [ district] s chool? _ ____ ( Y/N)
____ A sian/Pacific I slander
Last s chool a ttended:
____ B lack ( not H ispanic)
School N ame:_______________________ D istrict: _ ____________
____ H ispanic
City: _ ___________________ S tate: _ ______ Z ip: _ ____________
____ W hite ( not H ispanic)
Is t his s tudent t he s ubject o f a c ourt o r c ustody o rder? _ ____ ( Y/N)
____ O ther
If y es, p lease p rovide a c opy o f t he o rder t o t he s chool.
Language:
Exceptional S tudent S ervices:
-‐Spoken a t h ome: _ ___________________
Has t his s tudent e ver r eceived s ervices a s a n E xceptional S tudent? _ ____ ( Y/N)
-‐First s poken b y s tudent: _ ___________________
If y es, p lease i ndicate t he s tudent’s e xceptionality: _ ___ G ifted _ ___ T alented
-‐Most o ften s poken b y s tudent: _ ______________
Other: _ ________________________________________________________
PARENT/GUARDIAN I NFORMATION
Last N ame _ __________________________ F irst N ame _ _____________________________ R elation _ ______________
Address _ __________________________ A pt. _ _______ Z ip C ode _ ______
D oes t he s tudent r eside a t t his a ddress? _ ____ ( Y/N)
Phone N umbers:
Home _ ___________________________ C ell____________________________ W ork _ __________________________
Last N ame _ __________________________ F irst N ame _ _____________________________ R elation _ ______________
Address _ __________________________ A pt. _ _______ Z ip C ode _ ______
D oes t he s tudent r eside a t t his a ddress? _ ____ ( Y/N)
Phone N umbers:
Home _ ___________________________ C ell____________________________ W ork _ __________________________
Person w ith w hom t he s tudent l ives i f n ot t he p arent/guardian:
Last N ame _ __________________________ F irst N ame _ _____________________________ R elation _ ______________
Address _ __________________________ A pt. _ _______ Z ip C ode _ ______
D oes t he s tudent r eside a t t his a ddress? _ ____ ( Y/N)
Phone N umbers:
Home _ ___________________________ C ell____________________________ W ork _ __________________________
TRANSPORTATION
Does y our c hild n eed a b us s top? _ ____ ( Y/N)
I f y es, y ou m ust f ill o ut a b us s top r equest f orm.
People a uthorized t o p ick u p s tudent:
Name________________________________ H ome P hone _ __________________ W ork P hone _ __________________
Name________________________________ H ome P hone _ __________________ W ork P hone _ __________________
Name________________________________ H ome P hone _ __________________ W ork P hone _ __________________
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