High School Enrollment Form

HIGH SCHOOL ENROLLMENT FORM

Enrollment Date:   Campus or Program:

Student Information

Date of Birth:   Student ID (if assigned):

Gender:   Preferred Name:

Primary Phone:   Secondary Phone:

Parent / Guardian Information

Relation to Student:   Phone:

Relation to Student:   Phone:

Emergency Contacts

Relation:   Phone:

Relation:   Phone:

Residency and Custody

I certify that the student resides at the address listed above: Yes   If no, describe living arrangement:

Residency documentation provided (select all that apply):

Driver's license or state ID   Utility bill   Lease or rental agreement   Other (describe below)

Is there a custody or guardianship order in effect? Yes No   If yes, submit a certified copy to the school office.

Previous School / Academic Information

Last Date of Attendance:   Current GPA:

Special Programs / Services (select all that apply):

IEP (Individualized Education Program)   504 Plan   ESOL / ELL Services   None

Medical Information

Primary Care Physician:   Phone:

Immunization records provided: Yes No

Transportation

Student will: Ride bus Walk Be driven

Consents and Authorizations

By signing below, I certify that the information provided on this enrollment form is true, complete, and accurate to the best of my knowledge. I understand that intentional misrepresentation of residency or other information may result in disenrollment or other administrative action.

I authorize school personnel to obtain or release academic and health records necessary to effect enrollment and placement, including records from the previous school. I authorize the school to disclose and discuss information with emergency contacts listed above as necessary for the health and safety of the student.

In the event of a medical emergency, if I cannot be reached, I authorize school personnel to seek emergency medical treatment for the student. I understand the school will make reasonable efforts to notify me before emergency treatment is given.

Field trip and activity consent: I give permission for my child to participate in school-sponsored field trips and activities under school supervision, with notice provided in advance.

Medication administration at school: I authorize school staff to administer medication to my child in accordance with school policy and upon submission of required physician/parent authorization forms.

Photo and directory information release: I consent to the school’s use of my child’s image or directory information for school publications and announcements.   I do not consent

Acknowledgment of Policies

I acknowledge receipt of and agree to comply with applicable school policies, including but not limited to attendance, student code of conduct, dress code, and technology acceptable use. I understand that failure to comply with school policies may result in disciplinary action as set forth in the student handbook.

I understand that state and local law may require the school to withdraw or place restrictions on a student if required documentation, including immunization records or proof of residency, is not provided in accordance with district policies.

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