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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.
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
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