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J. F Wahl School Registration Form
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* Indicates required question
Email
*
Your email
Student Status
*
New
Returning
First Name:
*
Your answer
Middle Name:
Your answer
Last Name:
*
Your answer
Birthdate:
*
MM
/
DD
/
YYYY
Gender:
Male
Female
Clear selection
Next Year Grade:
*
1st
2nd
3rd
4th
5th
6th
Kindergarten
SSN (Optional):
Your answer
Hispanic/Latino Ethnicity:
Yes
No
Clear selection
Primary Race (Please select only ONE).
American Indian or Alaska Native: (A person having orgins in any of the original peoples of North and South America, Including Central America, and who maintains tribal affiliation or community attachment)
Asian: (A person having orgins in any of the origical peoples of Far East, Souteas Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Phillippine 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 people of Europe, Middle East or North Africa)
Language Spoken at Home:
*
Your answer
Parent/Guardian 1:
Name:
Your answer
Parent/Guardian 1:
Relationship to Student:
Your answer
Parent/Guardian 1:
Language of Correspondence
Your answer
Parent/Guardian 1:
Mailing Address:
Physical Address:
Your answer
Parent/Guardian 1:
City:
Your answer
Parent/Guardian 1:
State:
Your answer
Parent/Guardian 1:
Zip Code:
Your answer
Parent/Guardian 1:
Email:
Your answer
Parent/Guardian 1:
Home Phone:
Your answer
Parent/Guardian 1:
Cell Phone:
Your answer
Parent/Guardian 1:
Work Phone:
Your answer
Parent/Guardian 1:
*Alert Phone:
*Alert Phone is used by the district's automated phone message system.
Your answer
Parent/Guardian 1:
Student Primarily Resides with this Guardian.
Yes
No
Clear selection
Parent/Guardian 2:
Name:
Your answer
Parent/Guardian 2:
Relationship to Student:
Your answer
Parent/Guardian 2:
Language of Correspondence:
Your answer
Parent/Guardian 2:
Mailing Address:
Your answer
Parent/Guardian 2:
City
Your answer
Parent/Guardian 2:
State:
Your answer
Parent/Guardian 2:
Zip Code:
Your answer
Parent/Guardian 2:
Email:
Your answer
Parent/Guardian 2:
Home Phone:
Your answer
Parent/Guardian 2:
Cell Phone:
Your answer
Parent/Guardian 2:
Work Phone:
Your answer
Parent/Guardian 2:
*Alert Phone:
*Alert Phone is used by the district's automated phone message system.
Your answer
Parent/Guardian 2:
Student Primarily Resides with this Guardian.
Yes
No
Clear selection
Student: City of Birth
Your answer
Student: State of Birth
Your answer
Student: Birth Country:
Your answer
Travel Information: Travel To School (Please check one)
*
Bus
Drives Self
Parent/Guardian (includes walkers, child care vans, etc.)
District Paid Transportation
Travel Information: Travel From School (Please check one)
*
Bus
Drives Self
Parent/Guardian (Includes walker, child care vans, etc.)
District Paid Transportation
Is the child a dependent of an active reserve member of a branch of the United States Armed Services?
Yes
No
Clear selection
If this child resides in a household with an active reserve member of a branch of the United States Armed Services, please select the branch below.
Active Duty - US Army
Active Duty - US Coast Guard
Reserves - US Marines
Active Duty - US Air Force
Reserves - US Army
National Guard - US Air Force
Active Duty - US Marines
Reserves - US Navy
Parents serve in multiple branches
Clear selection
Emergency Contact Information (Contacts other than Guardians to be called in case of an emergency)
Your answer
Does this child have internet access at home?
*
No
Yes
If there is no Internet Access, what is the reason this child does Not have internet Access?
Not Available
Not Affordable
Not Applicable
Other
Clear selection
Is the Internet Performance Acceptable for learning activities?
*
Yes- experience very few or no interruptions in learning activities caused by poor internet performance in the primary place of residence.
Sometimes- regularly experiences interruptions in learning activities internet caused by poor internet performances in their primary place of residence.
No- unable to complete learning activities due to poor internet performance in their primary place of residence.
Other:
What kind of devices does this child use most often to complete learning activities away from school?
Desktop Computer
Laptop Computer
Tablet
Chromebook
Smartphone
None
Other
Clear selection
What is the source of this primary learning device?
District Provided
Personal
Other
Clear selection
What is the child's access to this primary learning device?
Shared
Not Shared
Clear selection
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