Original: Student Cumulative Folder | Enfield Public Schools | Dark gray areas for Office Use Only |
Copies: Office, Nurse, Guidance | Registration Information | Entry Date |
Student First Name | Student Middle Name (Full) | Student Last Name | Suffix | Grade | State ID: |
| | | | Student Gender Male Female | Student ID: |
Date of Birth | Ethnicity - Please respond to Questions 1 & 2: (Official Federal Codes) | US Citizen: | School Name: |
Place of Birth (City, State) | 1. Is the student Hispanic/Latino Yes No 2. What is the student's race? <Control or Command Click to choose more than one> (check one or more even if you answered "Yes" to the Hispanic/Latino question) | *If No, show proof of immigration status.
Dominant Language | School #: Counselor: Grade: Homeroom: Team: |
Parent/Guardian #1 Student Lives with: Yes No | Father Mother Guardian Step Parent Foster Agency Other |
Name: Address: Parent Marital Status: Check One: Married Single Divorced Separated (Child custody - Proof needed if Divorced or Separated) | Home Phone:
Work Phone:
Cell Phone: | Place of employment |
| email: |
Parent/Guardian #2 Student Lives with: Yes No | Father Mother Guardian Step Parent Foster Agency Other |
Name: Address: Parent Marital Status: Check One: Married Single Divorced Separated (Child custody - Proof needed if Divorced or Separated) | Home Phone:
Work Phone:
Cell Phone: | Place of employment |
| email: |
Emergency Contact (Other than Parent / Guardian) | Relationship | Emergency Contact Phone: (Home) (Cell) |
1. 2. | 1. 2. | 1. Home Phone: Cell Phone: 2. Home Phone: Cell Phone: |
Physician Name | Physician Phone | Hospital Preference | Allow Photo / Video (ex. Photo ID, Class Picture) Yes (If Yes, your decision will remian in effect until parent/guardian changes) No |
Previous / Current School: Homeschooled: Yes No | Preschool Experience Yes No |
School Name: Grade Student Withdrew: Street Address: Last Day Student Attended: City: , State: Zipcode: Special Education Yes No ........................................................................................... ....... .504 Plan... Yes No | Birth to Three Program Yes No
Preschool Name: Daycare Name: Address: Start Date: End Date: #Yrs: |
Daycare Facility | Travel Information | Lunch Code: |
Name: Phone: Address: | [_] Bus AM#_____ [_] Bus PM#_____ [_] Daycare Van_____ [_] Walker_____ | SPED: ELL: |
Sibling(s) Names/Grade/DOB:
Name: Grade: DOB: Name: Grade: DOB: Name: Grade: DOB: | Updated February 9, 2016 |
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