Student Enrollment Information 2017/2018
Student First Name:
Your answer
Student Last Name:
Your answer
Preferred Name:
If different from legal name
Your answer
Gender:
Birthdate:
(Month/Date/Year)
MM
/
DD
/
YYYY
District of Residence:
2017/2018 Grade:
Is Student Hispanic/Latino?
Race--Choose one or more of the following:
Required
Main Phone Number:
xxx-xxx-xxxx Please include dashes.
Your answer
Mailing Address:
Your answer
City:
Your answer
State:
Your answer
Zip Code:
Your answer
Father's First Name:
Your answer
Father's Last Name:
Your answer
Father's Cell Phone:
xxx-xxx-xxxx Please include dashes.
Your answer
Father's Work Phone:
xxx-xxx-xxxx Please include dashes.
Your answer
Father's Email Address:
Your answer
Mother's First Name:
Your answer
Mother's Last Name:
Your answer
Mother's Cell Phone:
xxx-xxx-xxxx Please include dashes.
Your answer
Mother's Work Phone:
xxx-xxx-xxxx Please include dashes.
Your answer
Mother's Email:
Your answer
#1 Emergency Contact Name & Phone Number:
We will always call parents first, but in the event of an emergency please list someone else who could come to get your child if we cannot contact you.
Your answer
#2 Emergency Contact Name & Phone Number:
Your answer
#3 Emergency Contact Name & Phone Number:
Your answer
Is this student the oldest child currently attending Edith Bowen Laboratory School?
Does your child currently have an IEP?
Siblings Attending Edith Bowen Laboratory School:
Your answer
Please list any allergies or health concerns we should be aware of:
Your answer
Additional Comments:
Your answer
May we share your family's phone, address, and email addresses with the PTA and in the student directory? Yes or No
The purpose of this is to protect such individuals' rights to privacy by limiting the availability of student information without parental consent per Federal FERPA (Family Educational Rights and Privacy Act), 20 USC Section 1232g/34 CFR Part 99.
Your answer
Email address(es) to receive ongoing school informational emails:
Since most of our school correspondence is done through email, please list all email addresses to be entered into OneCallNow (our online message system) which is used to send ongoing school informational and emergency emails.
Your answer
Your answer
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