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Covington -Douglas Online Enrollment Packet
Please fill out all information requested completely and accurately. Thank you!
Child's Legal First Name *
Your answer
Child's Legal Middle Name *
Your answer
Child's Legal Last Name *
Your answer
Name child goes by if different than above(what they want to be called in the classroom).
Your answer
Current Grade *
SSN
Your answer
Date of Birth *
(MM/DD/YYYY)
Your answer
Birthplace City State *
Your answer
Mailing Address *
Your answer
Home Street Address *
Your answer
City State Zip *
Your answer
Gender *
Are you of Hispanic/Latino culture or origin? *
Ethnic Group: You may choose more than one (example, if you have been issued a Tribal Card, please check Native American as well as another) *
Required
US Citizen *
Last School Attended *
Your answer
Is a language other than English used in the home? *
If Yes, what is that language
Your answer
If Yes, is that other language spoken in the home
Student resides with *
Are there Legal/Custody Papers pertaining to this child? Please note, the school must have a copy of the court order on file declaring custody arrangement. *
Guardian 1 First Name *
Your answer
Guardian 1 Last Name *
Your answer
Guardian 1 Home Phone Number *
Your answer
Guardian 1 Cell Phone Number *
Your answer
Guardian 1 Mailing Address *
Your answer
Guardian 1 City, State, Zip Code *
Your answer
Guardian 1 E-Mail Address
Your answer
Guardian 1 Place Of Employment
Your answer
Guardian 1 Work Phone Number
Your answer
Guardian 2 First Name
Your answer
Guardian 2 Last Name
Your answer
Guardian 2 Home Phone Number
Your answer
Guardian 2 Cell Phone Number
Your answer
Guardian 2 Mailing Address
Your answer
Guardian 2 City, State, Zip
Your answer
Guardian 2 E-Mail Address
Your answer
Guardian 2 Place Of Employment
Your answer
Guardian 2 Work Phone Number
Your answer
Emergency Contact First Name (other than Guardian 1 or 2) *
Your answer
Emergency Contact Last Name *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Relationship To Child *
Your answer
Please list any important medical information and/or food allergies for student. If your child has a food allergy, please ask office for form to fill out.
Your answer
List other children in the household attending Covington-Douglas Public School. Please list name and grade.
Your answer
Pick Up List - Please list names and phone numbers of people with permission to pick up your children.
Your answer
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