Registration Form 2020
Elmwood Park Public Schools
STUDENT DATA
Grade: *
Student Name: (First Middle Last) *
(As is appears on the student's birth certificate or legal document)
Gender: *
Date of Birth: *
MM
/
DD
/
YYYY
Birthplace: *
City, State OR Country (if outside of the U.S.)
Language First Acquired: *
Language most often spoken at home: *
Does the child need ESL (English as a Second Language)? *
Ethnicity: *
Required
Home Address: *
Home Phone Number: *
FAMILY DATA
Student lives with: *
Required
Father/Guardian Name: *
Please type "none" if not applicable.
Father's/Guardian's Cell Phone Number: *
Please type "none" if not applicable.
Father's/Guardian's Work Phone Number: *
Please type "none" if not applicable.
Father's/Guardian's Email Address: *
Please type "none" if not applicable.
Father's/Guardian's Home Address (if different than the student's):
Is the Father/Guardian allowed to pick up the student? *
Is the Father/Guardian an Emergency/Medical Contact? *
Mother/Guardian Name: *
Please type "none" if not applicable.
Mother's/Guardian's Cell Phone Number: *
Please type "none" if not applicable.
Mother's/Guardian's Work Phone Number: *
Please type "none" if not applicable.
Mother's/Guardian's Email Address: *
Please type "none" if not applicable.
Is the Mother/Guardian allowed to pick up the student? *
Mother's/Guardian's Home Address (if different than the student's):
Is the Mother/Guardian an Emergency/Medical Contact? *
SPECIAL CIRCUMSTANCES
Please describe any circumstances regarding custody/residency that exist. Provide appropriate documentation. *
Please type "none" if not applicable.
SIBLINGS
Please provide information for EACH sibling that attend an Elmwood Park school. Please type "none" if not applicable.
Provide sibling's full name, grade, and school attending in Elmwood Park: *
EMERGENCY/MEDICAL CONTACTS
* Provide information OTHER than Parents/Guardians.
** Any contact listed will be allowed to pick up child, unless otherwise stated by parent. Student will not be released to anyone
that is not listed as an emergency contact.
Emergency Contact #1 Name: *
Please type "none" if not applicable.
Emergency Contact #1 Phone Number: *
Please type "none" if not applicable.
Emergency Contact #2 Name: *
Please type "none" if not applicable.
Emergency Contact #2 Phone Number: *
Please type "none" if not applicable.
EDUCATIONAL INFORMATION
Is it first time entering school in United States? *
Date that student entered United States (if from another country):
MM
/
DD
/
YYYY
If your child was not born in the US, what grade did he or she enter in a US school?
Is this the student's first time entering school in the Elmwood Park School District? *
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