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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.
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* Indicates required question
Elementary or Secondary School District in which the student lives
*
Clay City Elementary
East Side Elementary
Forest Park Elementary
Jackson Township Elementary
Meridian Elementary
Staunton Elementary
Van Buren Elementary
Clay City Jr./Sr. High School
North Clay Middle School
Northview High School
Last Name
*
Your answer
First Name
*
Your answer
Student's Legal Middle Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Primary Phone #
*
Your answer
Grade Level ( for 21-22 school year)
*
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Required
Has your child received special services (IEP, 504) at a previous school?
*
Yes
No
Other:
Student primary Address (911) include city and zip code
*
Your answer
Student Mailing Address if different than the primary address
Your answer
County
*
Your answer
Language
*
Your answer
Is this student Hispanic/Latino?
*
Yes
No
Student Race
*
American Indian
Asian
Black
Hispanic/Latino
Multiracial
Native Hawaiian
White
Father/Guardian: (Last, First)
*
Your answer
Father/Guardian Home Phone #
Your answer
Father/Guardian Cell Phone #
Your answer
Father/Guardian Work Phone #
Your answer
Guardian Email
Your answer
Mother/Guardian (Last, First)
Your answer
Mother/Guardian Home Phone #
Your answer
Mother/Guardian Cell Phone #
Your answer
Mother/Guardian Work Phone #
Your answer
Has this student ever attended school in Indiana?
*
No
Yes
School (or pre-school) this child last attended:
Your answer
Name of siblings in Clay Community Schools:
Your answer
Name and relationship of person(s) with whom child resides:
Your answer
Name of person enrolling student / relationship to the student:
*
Your answer
Is there anyone, by court order who should not pick up your child from school?
*
Yes
No
Other:
Emergency Information: Person other than parents to call if your child is ill.
Your answer
Does child have any health related problem, physical handicap or allergies? Yes or No Describe:
Your answer
Is your child on any prescribed medications?
Yes
No
Clear selection
Will medication need to be given at school?
Yes
No
Clear selection
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