Union City Enrollment Form
Grade:
Last Name:
Your answer
Child's First Name:
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Middle Name:
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Date of Birth:
MM
/
DD
/
YYYY
Gender:
Place of Birth (City,State):
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Mailing Address:
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City,State:
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Zip Code:
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Physical Address(If different than mailing):
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City,State:
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Zip Code:
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School Previously Attended:
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Please check any special programs in which the student has participated:
Please provide a brief explanation of services provided:
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Race:
Required
Transportation:
Bus Number:
Your answer
Are you a transfer student?
Mother/Guardian Name:
Your answer
Mother/Guardian Employer:
Your answer
Mother/Guardian Cell Phone:
Your answer
Mother/Guardian Work Phone:
Your answer
Father/Guardian Name:
Your answer
Father/Guardian Employer:
Your answer
Father/Guardian Cell Phone:
Your answer
Father/Guardian Work Phone:
Your answer
Parent/Guardian Email:
Your answer
*Important Note:
Space has been provided for two emergency contacts, please list your contacts in the order you would like them to be called. We will make every effort in the event of an emergency to contact someone on the list you have provided. If no emergency contacts can be reached, please be aware UCPD and/or OKDHS may be contacted as a last resort.

Thank you,
Union City Elementary

Emergency Contact #1 Name:
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Relationship:
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Phone Number:
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Emergency Contact #2 Name
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Relationship:
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Phone Number:
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List any allergies:
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Please choose one of the following:
By typing your initials on the line below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
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