Student’s Proof of Age Sample Clauses

Student’s Proof of Age. Present one of the following:  A certified copy of a birth certificate; or  A federal, state, county, or school document with date of birth Immunization/Health Certificates  Current Immunization record from Health Provider (form available in enrollment forms)  Notarized Conscientious Objector form (available in enrollment forms) Primary Household Information: Please include full legal names as they appear on a Driver’s License or other official ID. Street Address: Apt/Unit # City: State: Zip: *Proof of Residency must be turned in with enrollment forms. See front cover for more info Is this address within the Xxxxxxxxxx School District Boundaries? Y or N (Please fill out Enrollment Options form if household address is outside of District lines) Primary Parent/Guardian #1: Last Name: First Name: Middle Name: Date of Birth: / / Relationship to student: Gender: M or F Email Address: Cell #: Work #: Employer: Legal Guardian? Y or N Primary Parent/Guardian #2: Last Name: First Name: Middle Name: Date of Birth: / / Relationship to student: Gender: M or F Email Address: Cell #: Work #: Employer: Legal Guardian? Y or N Other Members: Please list full names of all other children and/or adults living at this address. First, Middle, Last Name Date of Birth Gender Relationship to student Preschool Screened If yes, list location / / M / F Yes / No / / M / F Yes / No / / M / F Yes / No / / M / F Yes / No / / M / F Yes / No Non-Household Emergency Contact- Please list someone other than Parent/Guardian Emergency Contact Name: Address: Home Phone: Work Phone: Cell Phone: Relationship to student: Secondary Household Information (if applicable) Street Address: Apt/Unit # City: State: Zip: Is this address within the Xxxxxxxxxx School District Boundaries? Y or N (Please fill out Enrollment Options form if household address is outside of District lines) Primary Parent/Guardian #1: Last Name: First Name: Middle Name: Date of Birth: / / Relationship to student: Gender: M or F Email Address: Cell #: Work #: Employer: Legal Guardian? Y or N Student Information: Please enter the student’s full legal name as it appears on their birth certificate Last Name: First Name: Middle Name: Date of Birth: / / Current Age: Gender: M or F Enrolling in Grade: Name student goes by: Previous School attended: Previous school City/State: / Dates of att.: Has this student attended Xxxxxxxxxx Schools in the past: Y / N Special Services Does this student currently receive specialized services on an ...