Sparta Area Schools Pre-Registration Form
This data will allow us to create a student account and begin the enrollment process. PLEASE ALSO MAKE AN APPOINTMENT AT THE LINK FOLLOWING THIS FORM TO COMPLETE YOUR STUDENT'S ENROLLMENT.
Student Information:
Student's Legal Last Name *
Your answer
Student's Legal First Name: *
Your answer
Student's Legal Middle Name
Your answer
Student's Gender *
Student's Date of Birth *
MM
/
DD
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YYYY
Address: Street, Apt # *
Your answer
Address: City *
Your answer
Address: State *
Your answer
Address: Zip Code *
Your answer
Primary Phone Number *
format ex. 000-000-0000
Your answer
Grade Level *
Transportation Information:
Transportation *
Student may have only one established pick up and drop off location. Check the situation that pertains to your child's needs.
Alternate Location for Transportation - Name of Responsible Adult:
Provide name of responsible adult for alternate address if there is a student need.
Your answer
Alternate Location for Transportation - Address:
Provide information for alternate address if there is a student need.
Your answer
Alternate Location for Transportation - Phone Number:
Provide contact phone number for responsible adult at alternate address if there is a student need.
Your answer
Parent/Guardian Information
Please provide information for the parent/guardian that is living in the home with the student. Non-custodial information can be submitted at your enrollment appointment.
Guardian #1's Name *
parent/guardian that is in the home with the student
Your answer
Relationship to the Student *
Guardian #1's Employer
Your answer
Guardian #1's Work Phone Number
format: 000-000-0000
Your answer
Guardian #1's Secondary/Cell Phone
format: 000-000-0000
Your answer
Guardian #2's Name
parent/guardian that is in the home with the student
Your answer
Relationship to Student
Guardian #2's Employer
Your answer
Guardian #2's Work Phone Number
format: 000-000-0000
Your answer
Guardian #2's Secondary/Cell Phone
format: 000-000-0000
Your answer
Guardian email address *
Your answer
Home Language Survey
Affirmative response to either required question indicates a student who is potentially eligible for bilingual services.
Does your child speak or understand a language other than English? *
If yes, what is the language?
Your answer
If yes, is that the first language the child learned to speak or understand?
Is there a language other than English spoken regularly in the home environment? *
If yes, what is that language?
Your answer
Ethnicity
Please choose the student's ethnicity: *
Family Characteristics
Please choose any of the following that are applicable:
Check all that apply to your family.
Previous School Information
Name of Previous School
Your answer
Street Address of Previous School
Your answer
City of Previous School
Your answer
Phone Number of Previous School
format: 000-000-0000
Your answer
Fax Number of Previous School
format: 000-000-0000
Your answer
Previous Services
Has the student received any of the following special services in his/her previous school? Check all that apply to the student. Please bring in a copy of the student's IEP if applicable.
Emergency Contact Information
Emergency Contact #1 *
Name (last, first)
Your answer
Relationship to the Student: *
Emergency Contact #1 Primary Phone Number *
format: 000-000-0000
Your answer
Emergency Contact #1 Secondary Phone Number
format: 000-000-0000
Your answer
Emergency Contact #2
Name (last, first)
Your answer
Relationship to the Student:
Emergency Contact #2 Primary Phone Number
format: 000-000-0000
Your answer
Emergency Contact #2 Secondary Phone Number
format: 000-000-0000
Your answer
Emergency Contact #3
Name (last, first)
Your answer
Relationship to the Student:
Emergency Contact #3 Primary Phone Number
format: 000-000-0000
Your answer
Emergency Contact #3 Secondary Phone Number
format: 000-000-0000
Your answer
Household Members
Please list ALL people currently living in your household including the student you are enrolling.
Household Member #1 (Student you are enrolling): *
Please list the student first
Your answer
Household Member #1 Relationship to Student: *
Household Member #1 Sparta Student? *
Household Member #1 Date of Birth: *
MM
/
DD
/
YYYY
Household Member #2 Name (Parent/Guardian of Student): *
Parent/Guardian
Your answer
Household Member #2 Relationship to Student: *
Household Member #2 Sparta Student *
Household Member #2 Date of Birth: *
MM
/
DD
/
YYYY
Household Member #3 Name:
Your answer
Household Member #3 Relationship to Student:
Household Member #3 Sparta Student?
Household Member #3 Date of Birth:
MM
/
DD
/
YYYY
Household Member #4 Name:
Your answer
Household Member #4 Relationship to Student:
Household Member #4 Sparta Student?
Household Member #4 Date of Birth:
MM
/
DD
/
YYYY
Household Member #5 Name:
Your answer
Household Member #5 Relationship to Student:
Household Member #5 Sparta Student?
Household Member #5 Date of Birth
MM
/
DD
/
YYYY
Household Member #6 Name:
Your answer
Household Member #6 Relationship to Student:
Household Member #6 Sparta Student?
Household Member #6 Date of Birth:
MM
/
DD
/
YYYY
Housing Status
Do you live in a traditional single family home? *
Are you currently living in transitional housing or living with relatives/friends? *
Do you live in a shelter, hotel/motel, car, park, camper, abandoned building? *
Do yo have another temporary housing situation? *
If yes, please describe briefly:
Your answer
Family History
Have you moved within the last 36 months for temporary agricultural or fishing work? *
Has your child lived in more than two homes within the past three years? *
Have you ever used services of any county, family or social agency? *
Is there any history of learning disabilities in the family? *
Does your child have any emotional/physical problems the teacher should be aware of? *
Has your child experienced any stressful family issues (divorce, death, incarceration)? *
Has your child had any long term or chronic illness? *
Would you like to schedule an individual meeting to discuss specific concerns regarding your child? *
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