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 Mt. Vernon-Enola Elementary School Open House Registration
This form contain the following sections. 

1. Parent/Student Information
2. Continued Student Information
3. Military Dependency
4. MVE Elementary Parent Volunteer Interest Survey 
5. MVE Clinic Record
6. MVE Parent Student Statement of Responsibility
7. Student/Parent Compact
8. Device Usage Agreement
9. MVE Clinic Record

Please answer all questions to the best of your ability. Forms must be submitted once yearly on behalf of each student in order for the student to be assigned a new device in the new school year. 
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Parent/Student Information
Student Last Name *
Student First Name
Student Middle Name
Student Gender
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Student Grade
Clear selection
Date of BIrth *
MM
/
DD
/
YYYY
Student Age *
Physical (911) Address
Please indicate Street Name and #, City, State, and Zip
 *
Mailing Address (if different)
Parent/Guardian Contact Names and Information
Please fill out applicable questions in this section. At the LEAST, each student needs to have 1 primary contact and 1 emergency contact listed.
Primary Contact (First and Last Name) *
Primary Contact (Relationship to Student) *
Primary Contact - Phone*
This number will receive calls from the school district's automated phone and text message system.
 *
Primary Contact - Employer and Employer Phone
Secondary Contact - First and Last Name
Secondary Contact - Relationship to Student
Secondary Contact - Phone
This number will receive calls from the school district's automated phone and text message system.
Secondary Contact - Employer and Employer Phone
Your answer

Stepmother's Name and Phone
If applicable
Stepfather's Name and Phone
If applicable
With whom does the student reside?
Emergency Contacts (other than parent) 
Emergency Contact 1 - First and Last Name
Emergency Contact 1 - Relationship to Student
Emergency Contact 1 - Phone
Emergency Contact 2 - First and Last Name
Your answer

Emergency Contact 2 - Relationship to Student
Your answer

Emergency Contact 2 - Phone
Your answer

List anyone other than a parent who may pick up or check out student from school:
List anyone who IS NOT allowed to sign your child out of school:
Your answer

Are you or your spouse employed on a military base?
Do you approve of your child's name and picture being published on the following media outlets?

Newspaper, Social Media, School Website. 
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Parents will be notified before their child goes on any school-sponsored field trips during the regular school year. Do you give permission for your child to participate in school-sponsored field trips?
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Additional Information the school may need to know:
Please share any additional information you feel the school would need to know in order to best serve your child.
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