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2020-2021 Mabank Intermediate School New Student Enrollment
Please complete this form and record your digital signature at the bottom of the form.
Student's Last Name *
Student's First Name *
Student's Middle Name *
Name Suffix
Clear selection
Student Date of Birth: *
mm-dd-yyyy
Grade *
Gender *
Student Social Security Number *
xxx-xx-xxxx
Hispanic/Latino Ethnicity *
Race *
What is student's race? (Choose one or more)
Required
What language is spoken in your home? *
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
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 xxx-xxx-xxxx
Guardian (2) Email
Household 1
Custody Information
If parents are divorced or separated please provide the following - copy of court documentation is required.
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? *
If yes, what grade?
Has student attended Mabank ISD before?
Clear selection
Please list school student previously attended: *
School Name, City and State
Please check Special Programs Student has been enrolled in: *
Required
Sibling 1 Enrolled in Mabank ISD - Name
First & Last Name
Sibling 1 Campus:
Clear selection
Sibling 2 Enrolled in Mabank ISD - Name
First & Last Name
Sibling 2 Campus:
Clear selection
Sibling 3 Enrolled in Mabank ISD - Name
First & Last Name
Sibling 3 Campus:
Clear selection
Sibling 4 Enrolled in Mabank ISD - Name
First & Last Name
Sibling 4 Campus:
Clear selection
Enrolling Parent/Guardian Signature *
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