Annual Student Enrollment Form SY 17-18
ALL students (new & returning) enrolling to The Children's Guild DC Public Charter School (TCGDC) must submit this form by May 1, 2017.

After the deadline, your spot will be offered to the next family on the wait list.

If you have any problems completing this form, please do not hesitate to contact The Children's Guild DC PCS front office at enroll@tcgdc.org or 202-774-5442.

STUDENT INFORMATION
New or Returning Student *
Is this student new or returning to TCGDC?
Grade Level for the 2017-2018 school year. Please choose one. *
Student Last Name *
Your answer
Student First Name *
Your answer
Student Middle Name *
Your answer
Student Suffix
Your answer
Country of Birth *
Your answer
Has the student been in this country for less than one year? *
If yes, from which country did he/she move? *
If no type N/A
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Your answer
Apartment Number
Your answer
City *
Required
State *
Required
Zip Code *
Your answer
Ward *
Primary Telephone Number *
Your answer
Student's Gender *
Student's Home Language(s) *
Your answer
School Last Attended: *
If no school, enter NA
Your answer
City and State of Last School Attended *
Your answer
Type of School *
Last Year's Grade *
List any medical conditions of which the school should be aware (i.e. diabetes; asthma; etc.): *
If no medical conditions, type NA
Your answer
Please list any allergies and/or dietary restrictions for your child: *
If no restrictions, type NA
Your answer
Is there any reason why your child should not take part in physical education or recess? *
If yes, please explain
Your answer
I understand that if my child has a life threatening medical condition or life threatening allergies I must submit paperwork and a life-saving medical device (epi-pen, inhaler, etc) before the first day of school. If I do not, I understand that my child may not attend school until I submit all necessities. *
NO EXCEPTIONS will be made.
Individualized Education Plan (IEP)
Providing this information will allow TCGDC to connect families to our Special Education Team.
For students new to The Children's Guild, please indicate whether or not your child has a current IEP (Individualized Education Plan) *
If yes, IEP review date:
MM
/
DD
/
YYYY
Please indicate whether or not your child has a current Section 504 Accommodation Plan *
Student Siblings
Please list ALL siblings that will be attending TCGDC in this section.
Does the student have siblings that will enroll in TCGDC PCS? *
New or Returning Student *
Grade Level for the 2017-2018 school year. Please choose one *
Mark only one oval
Student Last Name (if no siblings type N/A) *
Your answer
Student First Name *
Your answer
Student Middle Name *
Your answer
Student Suffix
Your answer
Country of Birth *
Your answer
Has the student been in this country for less than one year? *
If yes, from what country did he/she move? (If no, type N/A)
Your answer
Student Date of Birth
MM
/
DD
/
YYYY
Student's Gender *
Student Home Language
Your answer
School Last Attended *
Your answer
City and State of Last School Attended *
Your answer
Type of School *
Last Year's Grade *
List any medical conditions of which the school should be aware of (i.e. diabetes, asthma, etc.) *
Your answer
Please list any allergies and/or dietary restrictions for your child *
Your answer
Is there any reason why this child should not take part in physical education or recess? *
If yes, please explain
Your answer
I understand that if my child has a life threatening medical condition or life threatening allergies I must submit paperwork and a life-saving medical device (epi-pen, inhaler, etc) before the first day of school. If I do not, I understand my child may not attend school until I submit all necessities.
Please indicate whether or not your child has a current IEP (Individualized Education Plan) *
If yes, IEP review date
MM
/
DD
/
YYYY
Please indicate whether or not your child has a current 504 Accommodation Plan. *
Do you have a third child enrolling in TCGDC? *
New or Returning Student *
Grade Level for the 2017-2018 school year. Please choose one. *
Student Last Name
Your answer
Student First Name
Your answer
Student Middle Name
Your answer
Student Suffix
Your answer
Country of Birth
Your answer
Has the student been in this country for less than one year?
If yes, from what country did he/she move?
Your answer
Student Date of Birth
MM
/
DD
/
YYYY
Student's Gender
Student's Home Language
Your answer
School Last Attended
Your answer
City and State of School Last Attended
Your answer
Type of School
Last Year's Grade
List any medical conditions of which the school should be aware (i.e. diabetes, asthma, etc.)
Your answer
Please list any allergies and/or dietary restrictions for your child
Your answer
Is there any reason why your child should not participate in physical education or recess?
If yes, please explain
Your answer
I understand that if my child has a life threatening medical condition or life threatening allergies I must submit paperwork and a life-saving medical device (epi-pen, inhaler, etc) before the first day of school. If I do not, I understand that my child may not attend school until I submit all necessities.
Please indicate whether or not your child has a current IEP (Individualized Education Program
If yes, IEP review date
MM
/
DD
/
YYYY
Please indicate whether or not your child has a current 504 Accommodation Plan
Do you have a fourth child enrolling in TCGDC? *
New or Returning Student *
Grade Level for the 2017-2018 school year. Please choose one. *
Student Last Name
Your answer
Student First Name
Your answer
Student Middle Name
Your answer
Student Suffix
Your answer
Country of Birth
Your answer
Has the student been in this country for less than one year?
If yes, from what country did he/she move?
Your answer
Student Date of Birth
MM
/
DD
/
YYYY
Student's Gender
Student's Home Language
Your answer
School Last Attended
Your answer
City and State of School Last Attended
Your answer
Type of School
Last Year's Grade
List any medical conditions of which the school should be aware (i.e diabetes, asthma, etc)
Your answer
Please list any allergies and/or dietary restrictions for your child.
Your answer
Is there any reason why your child should not participate in physical education or recess?
If yes, please explain
Your answer
Please indicate whether or not your child has a current IEP (Individualized Education Plan)
If yes, IEP review date
MM
/
DD
/
YYYY
Please indicate whether or not your child has a current 504 Accommodation Plan
Does the student have siblings enrolled in another school? *
Select all grades that apply. *
Required
List the name(s) of the school(s) the sibling(s) attend *
If not applicable, type NA
Your answer
Ethnicity/Race
Ethnic Designation: *
Race *
Choose one or more
Required
PARENT/GUARDIAN INFORMATION AND OTHER PRIMARY CAREGIVER INFORMATION*
1. Parent or Guardian Last Name *
Your answer
Parent or Guardian First Name *
Your answer
Military *
Relationship *
Your answer
Street Address *
Your answer
Apartment Number
Your answer
City *
Required
State *
Required
Zip Code *
Your answer
Preferred Language of Communication (Phone or E-mail) *
Your answer
Primary Number *
Your answer
Cell Number *
Your answer
Work Number *
place NA if not applicable
Your answer
Email Address *
Your answer
Employer's Name
Your answer
City
Your answer
State
Your answer
2. Parent or Guardian Last Name
Your answer
Parent or Guardian First Name
Your answer
Relationship
Your answer
Military Status
Street Address
Your answer
Apartment Number
Your answer
City
State
Zip Code
Your answer
Preferred Language of Communication (Phone or E-mail)
Your answer
Cell Number
Your answer
Email Address
Your answer
Employer's Name/Address
Your answer
City
Your answer
State
Your answer
Work number
Your answer
EMAIL COMMUNICATION
I would like to receive email messages from my child’s principal and TCGDC at the address listed above AND the address listed below. *
If you have a supplemental email address different than the one above
Your answer
IN CASE OF EMERGENCY
1. Emergency Contact Person (other than parent/guardian) *
Your answer
Relationship *
Your answer
Primary Number *
Your answer
Work Number
Your answer
Cell Number *
Your answer
Email Address
Your answer
Is this person allowed to pick your child/children up from school? *
Should this person be added to the LivingTree list?
Living Tree is a system we use to share important information (emergencies, school closings, etc) via email.
2. Emergency Contact Person (other than parent/guardian) *
Your answer
Relationship *
Your answer
Primary Number *
Your answer
Work Number
Your answer
Cell Number *
Your answer
Email Address
Your answer
Is this person allowed to pick your child/children up from school? *
Should this person be added to the LivingTree list?
LivingTree is a system we use to share important information (emergencies, school closings, etc) via email.
RESIDENCY STATUS
Check one *
Choose whether enrolling parent is a DC Resident or Nonresident
HOUSING STATUS
Check all that apply *
Based on your selection a staff member may follow up to see if you are interested in resources provided by TCGDC
Required
GENERAL INFORMATION
If you plan to enroll in school breakfast or lunch, select the standard or special meal option. *
Special meal details can be selected in the next section.
If you selected the special meal option choose the dietary restrictions and/or preferences for your child(ren). *
Questions about meals can be sent to bullockt@childrensguild.org
Required
How did you hear about the school *
Signature, Date, and Certification of Accuracy
* TCG agrees that the data/information provided in the Student Enrollment Form remain confidential and shall only be used for legitimate TCG business.
I completed this form and I certify that the information above is accurate. I understand that providing false information for purposes of defrauding the government is punishable by law. Form should not be signed prior to April 1. Information provided on this form should be applied consistently throughout enrollment documentation. *
Typed name acts as the signature of the Parent/Guardian with whom the student lives
Your answer
Person Completing This Form Is: *
Submission Date *
MM
/
DD
/
YYYY
Submit
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