Request edit access
Clay Community Schools New Student Enrollment Form 2021-22
This form is for students who will be new to the Clay Community School district in the fall of 2021.  Existing students DO NOT need to re-enroll.  
Sign in to Google to save your progress. Learn more
Elementary or Secondary School District in which the student lives *
Last Name *
First Name *
Student's Legal Middle Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Primary Phone # *
Grade Level  ( for 21-22 school year) *
Required
Has your child received special services (IEP, 504) at a previous school? *
Student primary Address (911) include city and zip code *
Student Mailing Address if different than the primary address
County *
Language *
Is this student Hispanic/Latino?   *
Student Race *
Father/Guardian: (Last, First) *
Father/Guardian Home Phone #
Father/Guardian Cell Phone #
Father/Guardian Work Phone #
Guardian Email
Mother/Guardian (Last, First)
Mother/Guardian Home Phone #
Mother/Guardian Cell Phone #
Mother/Guardian Work Phone #
Has this student ever attended school in Indiana? *
School (or pre-school) this child last attended:
Name of siblings in Clay Community Schools:
Name and relationship of person(s) with whom child resides:
Name of person enrolling student / relationship to the student: *
Is there anyone, by court order who should not pick up your child from school? *
Emergency Information:  Person other than parents to call if your child is ill.
Does child have any health related problem, physical handicap or allergies?  Yes or No Describe:
Is your child on any prescribed medications?
Clear selection
Will medication need to be given at school?
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Clay Community Schools.

Does this form look suspicious? Report

Google Forms