LHS New Student Enrollment Form

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Please complete this form and record your digital signature at the bottom. Documents required for registration are as follows: birth certificate, SSC, immunization record, parent/guardians DL & proof of residency (water, gas or electric bill). Please email these documents to the Registrar: lawlesskd@lisdeagles.net or bring in paper copies when you come for your appointment. The Registrar will call you for an appointment once records are requested and received from the previous school district.

Today's Date: *

YYYY

Student's Last Name *

Student's First Name *

Student's Middle Name *

Name Suffix

III

None

Clear selection

Student Date of Birth: *

mm-dd-yyyy

YYYY

Grade *

9th Grade

10th Grade

11th Grade

12th Grade

Gender *

Male

Female

Student Social Security Number *

xxx-xx-xxxx

Hispanic/Latino Ethnicity *

Yes, Is the student of Cuban, Mexican Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.

Not Hispanic/Latino

Race *

What is student's race? (Choose one or more)

American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American - A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

What language is spoken in your home most of the time? *

What language does your child speak most of the time? *

Custodial Parent or Guardian (1) First & Last Name: *

Household 1

Relationship to student: *

Custodial Parent or Guardian (1) Gender *

Household 1

Male

Female

Custodial Parent or Guardian (1) Date of Birth *

Household 1- mm-dd-yyyy

Custodial Parent or Guardian (1) Driver's License Number *

Household 1

Custodial Parent or Guardian (1)- Primary Phone Number *

Household 1 xxx-xxx-xxxx

Custodial Parent or Guardian (1) - Cell Phone Number

Household 1 xxx-xxx-xxxx

Custodial Parent or Guardian (1) - Work Phone Number

Household 1 xxx-xxx-xxxx

Custodial Parent or Guardian (1) Email *

Household 1

Custodial Parent or Guardian (1)Physical Address *

Household 1 - Number & Street

Custodial Parent or Guardian (1) City/Town *

Household 1

Custodial Parent or Guardian (1) Zip Code *

Household 1

Custodial Parent or Guardian (1) Mailing Address

If different from physical address. Number, Street, Town, State

Guardian (2) First & Last Name:

Household 1

Guardian (2) Relationship to student:

Household 1

Guardian (2) - Cell Phone Number

Household 1

Guardian (2) Email

Household 1

Custody Information

If parents are divorced or separated please provide the following - copy of court documentation is required.

Joint Custody

Sole Custody Mother

Sole Custody Father

Sole Custody Guardian

Other:_____________________________________________________________________________

Clear selection

Special Conditions:

Guardian First & Last Name

Household 2 - if parents are divorced or separated, please provide the following.

Guardian (2) Relationship to student:

Household 2

Guardian Primary Phone Number

Household 2

Guardian Email

Household 2

Guardian Mailing Address

Household 2- Number, Street, Town, State

Has student ever been retained? *

Yes

If yes, what grade?

Has student attended Lindale ISD before?

Yes

Clear selection

Please list the school student is transferring from: *

School Name, City and State

Foster Connection:

Student is currently in the conservatorship of the Department of Family and Protective Services

NOT currently in the conservatorship of the Department of Family and Protective Services

Please check Special Programs Student has been enrolled in: *

Special Education

504

Speech

Dyslexia

LEP/ESL/Bilingual

Reading Intervention

Math Intervention

Gifted & Talented

None

Required

Sibling 1 Enrolled in Lindale ISD - Name

First & Last Name

Sibling 1 Campus:

Early Childhood Center

College Street Elementary

Velma Penny Elementary

E. J. Moss Intermediate

Lindale Junior High

Lindale High School

Clear selection

Sibling 2 Enrolled in Lindale ISD - Name

First & Last Name

Sibling 2 Campus:

Early Childhood Center

College Street Elementary

Velma Penny Elementary

E. J. Moss Intermediate

Lindale Junior High

Lindale High School

Clear selection

Sibling 3 Enrolled in Lindale ISD - Name

First & Last Name

Sibling 3 Campus:

Early Childhood Center

College Street Elementary

Velma Penny Elementary

E. J. Moss Intermediate

Lindale Junior High

Lindale High School

Clear selection

Sibling 4 Enrolled in Lindale ISD - Name

First & Last Name

Sibling 4 Campus:

Early Childhood Center

College Street Elementary

Velma Penny Elementary

E. J. Moss Intermediate

Lindale Junior High

Lindale High School

Clear selection

List any/all chronic health conditions, allergies, medications taken.

Enrolling Parent/Guardian Signature *

The LHS counseling office will call you to proceed with your LHS registration once records are requested and received from the previous school.

Submit

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