ContractStudent Enrollment & Emergency Consent Form • June 21st, 2023
Perry Township Schools6548 Orinoco Avenue ∙ Indianapolis, Indiana 46227 ∙ 317.789.3700 School Name/Code STUDENT ENROLLMENT & EMERGENCY CONSENT FORM 24-25Enrollment Date Current Grade (based on # of years in H.S. if applicable) Graduation Year STUDENT INFORMATION Last First Middle Lineage (i.e. Jr, I, II, etc.) Male Female DOB Street Address City State Zip Code Is the name or rental agreement for the address listed in your name Yes No STUDENT BIRTH INFORMATION Place of Birth: City State County Born Outside of U.S.? Yes No If yes, which country Is the student a refugee? I-94 U.S. Arrival Date Resettlement Agencies (circle one) Catholic Charities - Exodus - Out of State Agency PARENT/GUARDIAN CONTACT INFORMATION Parent/Guardian 1 Parent/Guardian 2 Name Relationship to Student Address City, State, Zip Home # Work # Cell # Preferred Email: Name Relationship to Student Address City, State, Zip Home # Work # Cell # Preferred Email: STUDENT LIVES WITH: Who is Legal Guardian and/or has Legal C
ContractStudent Enrollment & Emergency Consent Form • May 2nd, 2019
Perry Township Schools6548 Orinoco Avenue ∙ Indianapolis, Indiana 46227 ∙ 317.789.3700 School Name/Code STUDENT ENROLLMENT & EMERGENCY CONSENT FORM Enrollment Date Current Grade (based on # of years in H.S. if applicable) Graduation Year STUDENT INFORMATION Last First Middle Lineage (i.e. Jr, I, II, etc.) Male Female DOB Street Address City State Zip Code Is the name or rental agreement for the address listed in your name Yes No STUDENT LIVES WITH: Guardianship* Both Parents Mother Only Father Only Mother & Stepfather Father & Stepmother Other If other, what is relationship to child? *If you marked anything other than "Both Parents," please indicate any other important custody information below: Who is Legal Guardian and/or has Legal Custody? Are there custodial/guardianship papers? Yes No If yes, papers must be provided. Is this a Foster child? Yes No Are you currently living in transition(doubled up with another family, in a shelter or in your vehicle)? Yes No STUDENT BIRTH INFORM
ContractStudent Enrollment & Emergency Consent Form • August 15th, 2019
Perry Township Schools6548 Orinoco Avenue ∙ Indianapolis, Indiana 46227 ∙ 317.789.3700 School Name/Code STUDENT ENROLLMENT & EMERGENCY CONSENT FORMEnrollment Date Current Grade (based on # of years in H.S. if applicable) Graduation Year STUDENT INFORMATION Last First Middle Lineage (i.e. Jr, I, II, etc.) Male Female DOB Street Address City State Zip Code Is the name or rental agreement for the address listed in your name Yes No STUDENT LIVES WITH: Guardianship* Both Parents Mother Only Father Only Mother & Stepfather Father & Stepmother Other If other, what is relationship to child? *If you marked anything other than "Both Parents," please indicate any other important custody information below: Who is Legal Guardian and/or has Legal Custody? Are there custodial/guardianship papers? Yes No If yes, papers must be provided. Is this a Foster child? Yes No Are you currently living in transition(doubled up with another family, in a shelter or in your vehicle)? Yes No STUDENT BIRTH INFORMATI
ContractStudent Enrollment & Emergency Consent Form • December 9th, 2021
Perry Township Schools6548 Orinoco Avenue ∙ Indianapolis, Indiana 46227 ∙ 317.789.3700 School Name/Code STUDENT ENROLLMENT & EMERGENCY CONSENT FORM 23-24 Enrollment Date (mm/dd/ccy) Current Grade (based on # of years in H.S. if applicable) Graduation Year STUDENT INFORMATION Last First MiddleLineage (i.e. Jr, I, II, etc.) Male Female DOBStreet Address City State ZipCode Is the name or rental agreement for the address listed in your name Yes No STUDENT BIRTH INFORMATION Place of Birth: City State CountyBorn Outside of U.S.? Yes No If yes, which country Is the student a refugee? I-94U.S. Arrival Date Resettlement Agencies (Select One) Catholic Charities Exodus Out of State Agency PARENT/GUARDIAN CONTACT INFORMATION Parent/Guardian 1 Parent/Guardian 2 NameRelationship to StudentAddressCity, State, ZipHome # Work #Cell #Preferred Email NameRelationship to StudentAddressCity, State, ZipHome # Work #Cell #Preferred Email STUDENT LIVES WITH: Who is Legal Guardian and/or has Legal Custody
ContractStudent Enrollment & Emergency Consent Form • June 18th, 2020
Perry Township Schools6548 Orinoco Avenue ∙ Indianapolis, Indiana 46227 ∙ 317.789.3700 School Name/Code STUDENT ENROLLMENT & EMERGENCY CONSENT FORM 2020-2021 Enrollment Date Current Grade (based on # of years in H.S. if applicable) Graduation Year STUDENT INFORMATION Last First Middle Lineage (i.e. Jr, I, II, etc.) Male Female DOB Street Address City State Zip Code Is the name or rental agreement for the address listed in your name Yes No STUDENT LIVES WITH: Guardianship* Both Parents Mother Only Father Only Mother & Stepfather Father & Stepmother Other If other, what is relationship to child? *If you marked anything other than "Both Parents," please indicate any other important custody information below: Who is Legal Guardian and/or has Legal Custody? Are there custodial/guardianship papers? Yes No If yes, papers must be provided. Is this a Foster child? Yes No Are you currently living in transition(doubled up with another family, in a shelter or in your vehicle)? Yes No STUDENT
ContractStudent Enrollment & Emergency Consent Form • December 9th, 2021
Perry Township Schools6548 Orinoco Avenue ∙ Indianapolis, Indiana 46227 ∙ 317.789.3700 School Name/Code STUDENT ENROLLMENT & EMERGENCY CONSENT FORM 22-23 Enrollment Date (mm/dd/ccy) Current Grade (based on # of years in H.S. if applicable) Graduation Year STUDENT INFORMATION Last First MiddleLineage (i.e. Jr, I, II, etc.) Male Female DOBStreet Address City State ZipCode Is the name or rental agreement for the address listed in your name Yes No STUDENT BIRTH INFORMATION Place of Birth: City State CountyBorn Outside of U.S.? Yes No If yes, which country Is the student a refugee? I-94U.S. Arrival Date Resettlement Agencies (Select One) Catholic Charities Exodus Out of State Agency PARENT/GUARDIAN CONTACT INFORMATION Parent/Guardian 1 Parent/Guardian 2 NameRelationship to StudentAddressCity, State, ZipHome # Work #Cell #Preferred Email NameRelationship to StudentAddressCity, State, ZipHome # Work #Cell #Preferred Email STUDENT LIVES WITH: Who is Legal Guardian and/or has Legal Custody
ContractStudent Enrollment & Emergency Consent Form • December 9th, 2021
Perry Township Schools6548 Orinoco Avenue ∙ Indianapolis, Indiana 46227 ∙ 317.789.3700 School Name/Code STUDENT ENROLLMENT & EMERGENCY CONSENT FORM 22-23 Enrollment Date (mm/dd/ccy) Current Grade (based on # of years in H.S. if applicable) Graduation Year STUDENT INFORMATION Last First MiddleLineage (i.e. Jr, I, II, etc.) Male Female DOBStreet Address City State ZipCode Is the name or rental agreement for the address listed in your name Yes No STUDENT BIRTH INFORMATION Place of Birth: City State CountyBorn Outside of U.S.? Yes No If yes, which country Is the student a refugee? I-94U.S. Arrival Date Resettlement Agencies (Select One) Catholic Charities Exodus Out of State Agency PARENT/GUARDIAN CONTACT INFORMATION Parent/Guardian 1 Parent/Guardian 2 NameRelationship to StudentAddressCity, State, ZipHome # Work #Cell #Preferred Email NameRelationship to StudentAddressCity, State, ZipHome # Work #Cell #Preferred Email STUDENT LIVES WITH: Who is Legal Guardian and/or has Legal Custody
ContractStudent Enrollment & Emergency Consent Form • December 17th, 2020
Perry Township Schools6548 Orinoco Avenue ∙ Indianapolis, Indiana 46227 ∙ 317.789.3700 School Name/Code STUDENT ENROLLMENT & EMERGENCY CONSENT FORM 21-22Enrollment Date Current Grade (based on # of years in H.S. if applicable) Graduation Year STUDENT INFORMATION Last First Middle Lineage (i.e. Jr, I, II, etc.) Male Female DOB Street Address City State Zip Code Is the name or rental agreement for the address listed in your name Yes No STUDENT LIVES WITH: Guardianship* Both Parents Mother Only Father Only Mother & Stepfather Father & Stepmother Other If other, what is relationship to child? *If you marked anything other than "Both Parents," please indicate any other important custody information below: Who is Legal Guardian and/or has Legal Custody? Are there custodial/guardianship papers? Yes No If yes, papers must be provided. Is this a Foster child? Yes No Are you currently living in transition(doubled up with another family, in a shelter or in your vehicle)? Yes No STUDENT BIRTH INF
