JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
New 4K Student Registration Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What is your student's full name?
*
Your answer
What is your student's date of birth?
*
MM
/
DD
/
YYYY
What is your student's gender?
*
Female
Male
Prefer not to say
Other:
What is your mailing address?
*
Your answer
What is your physical address if it is different than your mailing address? If it is the same, write NA
*
Your answer
If Sharon Community School was able to offer full day 4K, would you be interested in a full day experience for your child?
*
Yes
No
Is this student Hispanic or Latino?
*
Yes
No
Is this student: (Choose one or more.)
*
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Asian
White
Black or African American
Required
Place of Birth
*
Your answer
What is the primary language spoken at home?
*
Your answer
Has the student received services to improve their English skills?
*
Yes
No
Is this student a child of a military family?
*
Yes
No
Student lives with:
*
Both Parents
Parent and Step-Parent
Mother Only
Father Only
Legal Guardian
Both Parently (alternately)
Other:
If separated, who has legal custody?
Mother
Father
Joint Custody
Clear selection
If separated and sole custody, does the other parent have visitation/information rights? If answered "yes" please provide documentation to the school office.
Yes
No
Clear selection
Family Student Lives With:
Mother's Name
*
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
Your answer
Employer
Your answer
Work Phone Number & Extension
Your answer
Father's Name
*
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
Your answer
Employer
Your answer
Work Phone Number & Extension
Your answer
Second Family Information (If Applicable)
Name
Your answer
Relationship to Student
Your answer
Mailing Address
Your answer
Telephone Number
Your answer
Email
Your answer
Employer
Your answer
Work Phone Number & Extension
Your answer
Name of School Last Attended (If Applicable)
Name of School
Your answer
School Address
Your answer
School Phone Number
Your answer
Date Last Attended
MM
/
DD
/
YYYY
An Individualized Plan (IEP) is in place for:
*
Learning Disability
Emotional Disability
Speech/Language
Other
None
Required
Emergency Contacts: (Other than Parents/Guardians)
Name
Your answer
Relationship to Student
Your answer
Address
Your answer
Phone Number
Your answer
Name
Your answer
Relationship to Student
Your answer
Address
Your answer
Phone Number
Your answer
Please list, in order, of who should be contacted first in case of an emergency:
#1 Name, Relationship & Phone Number
*
Your answer
#2 Name, Relationship & Phone Number
*
Your answer
#3 Name, Relationship & Phone Number
*
Your answer
Census Information
Other Children Living in the Home who are Under 20 Years of Age
Name of Child
Your answer
Child's Age
Your answer
Child's Birthdate
MM
/
DD
/
YYYY
Name of Child
Your answer
Child's Age
Your answer
Child's Birthdate
MM
/
DD
/
YYYY
Child's Name
Your answer
Child's Age
Your answer
Child's Birthdate
MM
/
DD
/
YYYY
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Sharon Community School.
Report Abuse
Forms
