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Student Enrollment Form 2020-2021

Please complete the form below. Required fields marked with an asterisk *
Sex*
Answer Required

Student Address

State
Answer Required

Parent Contact Information # 1

Parent Contact Information # 2

Friend/Relatives Permission to Pick-Up/Amigos/familiares con permiso para recoger

Friend/Relatives Permission to Pick-Up/Amigos/familiares con permiso para recoger

Please answer the following questions.*
Answer Required
Yes
No
Has this student ever been expelled or in the process of being expelled from a previous school?/Ha sido, alguna vez, expulsado o en el proceso de tal, el estudiante mencionado?
Has this student been certified as having a chronic health problem?/Tiene algun problema cronico de salud?
Are there psychological or confidential reports available from the previous school?/Hay reports sicologicos o confidenciales disponibles de la escuela anterior?
Military Student Identifier - Please check one of the following*
Answer Required
Has the student ever qualified for any of the following programs?/Calificado alguna vez para algunos de estos programas?*
Answer Required
Yes
No
IEP
504
Special Education/Educacion Especial
Gifted Language/Lenguaje Avanzado
Gifted Math/Matematica Avanzada
English Language Learner/Aprendiz de ingles
Speech or Language Services/Servicio de Lenguaje o Habla
Title 1 Math/Title 1 Matematica
Title 1 Reading/Title 1 Lectura
Is the student Hispanic/Latino? (choose only one)/Es el estudiante Hispano/Latino? (Escoja solo uno)*
Answer Required
If the answer to the above question is yes, Please select "White" for the question below. What is the student's race?/Cual es la raza del estudiante?*
Answer Required

Please fill out the following information, if it does not apply please write "N/A". / Por favor Ilene la siguiente informacion, si esto no se refiere a su hijo escriba "N/A".

Check "Yes" or "No" to indicate if your child can have the following medications. / Marque "Si" o "No" si su hijo/ a puede tomar los siguientes medicamentos.*
Answer Required
Yes
No
Acetaminophen (Tylenol)
Aloe Vera Gel (Minor burns) / Quemaduras menores
Benadryl (Allergies) / Alegias
Chloroseptic Spray (Sore throat) / Para dolor de garganta
Emetrol (Upset stomach) / Para dolor de estomago
Ibuprofen (Motrin)
Pepto Bismol (Upset stomach) / Para dolor de estomago
Triple Antibiotic Cream (First Aid) / Primeros auxilios
Tums (Upset stomach) / Para dolor de estomago
Visine (Eye drops) / Gotas para ojos irritados
Answer Required
Please fill out the information below (Por favor de rellenar la información de abajo)*
Answer Required

Contact Information (Informacion de Contacto)

Confirmation Email
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