2019-2020 Reenrollment
This form is for students who are CURRENTLY attending Midtown Public Charter School who wish to reenroll for the following academic year. If you are a new student wishing to enroll at Midtown for the first time, please instead visit www.enrollatmidtown.com
If you have more than one child that you wish to reenroll, please fill out a separate form for each child.
After you complete this form application, please click "Submit." When you do, you should see a screen like the one pictured below. If you do not, then your application did not go through.
Please type your name (the person filling out this form) *
Please type your phone number (the person filling out this form) *
About the student
Student's first name - LEGAL NAME *
Student's first name - PREFERRED NAME or NICKNAME *
What name does your student like teachers to call him or her?
Student's last name *
What is the student's current lunch number? *
Student's mailing address *
Please include the FULL mailing address, including street number, street name, apartment number (if applicable), city, state, and zip code.
Student's birthday, including year *
What grade is the student currently in? *
What grade do you anticipate the student will be in next year (2019-2020)? *
What is the student's gender? *
If the student has a phone number, please list it here. Otherwise, please leave this question blank.
Who does the student live with? *
Student shirt size *
Student pants size *
Student shoe size *
What is the student's favorite subject? *
What is the student's favorite movie or TV show? *
What is the student's favorite book? *
What is the student's favorite song, artist, or band? *
What is the student's favorite sports team? *
What does the student enjoy doing when he or she is not in school? *
Is the student Hispanic/Latino? *
Which of the following is the student? Please check ALL that apply. *
Required
Please select one of the following. *
If applicable: Which school or schools did the student attend KINDERGARTEN? If the student did not attend a school for kindergarten, please lave blank.
If applicable: Which school or schools did the student attend for GRADE 1? If the student did not attend a school for grade 1, please lave blank.
If applicable: Which school or schools did the student attend for GRADE 2? If the student did not attend a school for grade 2, please lave blank.
If applicable: Which school or schools did the student attend for GRADE 3? If the student did not attend a school for grade 3, please lave blank.
If applicable: Which school or schools did the student attend for GRADE 4? If the student did not attend a school for grade 4, please lave blank.
If applicable: Which school or schools did the student attend for GRADE 5? If the student did not attend a school for grade 5, please lave blank.
If applicable: Which school or schools did the student attend for GRADE 6? If the student did not attend a school for grade 6, please lave blank.
If applicable: Which school or schools did the student attend for GRADE 7? If the student did not attend a school for grade 7, please lave blank.
If applicable: Which school or schools did the student attend for GRADE 8? If the student did not attend a school for grade 8, please lave blank.
About the Mother / Legal Guardian
Mother / Legal Guardian first name
Mother / Legal Guardian last name
Mother / Legal Guardian phone number
Mother / Legal Guardian secondary phone
Mother / Legal Guardian's mailing address
Please indicate if the address is the same as the student's full address, OR - in the "other" box - include the FULL mailing address, including street number, street name, apartment number (if applicable), city, state, and zip code.
Clear selection
Mother / Legal Guardian email address
If applicable: Mother / Legal Guardian occupation (otherwise, leave blank):
If applicable: Mother / Legal Guardian name of employer (otherwise, leave blank):
If applicable: Mother / Legal Guardian employer phone number / business phone number (otherwise, leave blank):
About the Father / Legal Guardian
Father / Legal Guardian first name
Father / Legal Guardian last name
Father / Legal Guardian phone number
Father / Legal Guardian secondary phone
Father / Legal Guardian's mailing address
Please indicate if the address is the same as the student's full address, OR - in the "other" box - include the FULL mailing address, including street number, street name, apartment number (if applicable), city, state, and zip code.
Clear selection
Father / Legal Guardian email address
If applicable: Father / Legal Guardian occupation (otherwise, leave blank):
If applicable: Father / Legal Guardian name of employer (otherwise, leave blank):
If applicable: Father / Legal Guardian employer phone number / business phone number (otherwise, leave blank):
Family information
If applicable: Please check
If applicable - In the case of divorce and separate: Who has legal custody? If not applicable, please leave this question blank.
If applicant is not living with both parents, please indicate with whom the child resides. If the applicant is living with both parents, please leave this question blank.
Please list the first name, middle name, last name, and date of birth (including year) for each of the student's siblings. If the applicant does not have any siblings, please leave this question blank.
Special services
Does the student currently receive any of the following services? If applicable, please check ALL that apply.
Language
What was the language the student first learned to speak? (First Language) *
What language does the student speak at home? (Home Language) *
What language does the student speak most often? (Primary Language) *
Medical Information
Physician documentation required
Does the student need to take medication at school (only physician prescribed) *
If the student needs to take medication at school (only physician prescribed) - Please list the medication. Otherwise, please leave this question blank.
If applicable, please list special medical issues. Otherwise, please leave this question blank.
If applicable, please list any allergies of the student. Otherwise, please leave this question blank.
Listed healthcare provider
Listed healthcare provider phone number
In the event of a medical emergency, MPCS will have the student transported to the closest doctor or medical facility for treatment. Parents/guardians will assume full responsibility for all charges incurred. If you have a preference for a particular hospital to transport your student in case of an emergency, please list it here. Otherwise, please leave this question blank. We cannot guarantee that in the case of a medical emergency we will be able to transport your student to the preferred hospital.
Transportation
How do you anticipate your student will leave school each day?
Clear selection
Emergency / Authorized Pick Up
The following person(s) may pick my child(ren) up from school and may also be called in case of emergency if the enrolling adult cannot be reached.
(if applicable) - Person 1, name: (otherwise, leave blank)
(if applicable) - Person 1, relationship to child: (otherwise, leave blank)
(if applicable) - Person 1, cell phone and alternative phone: (otherwise, leave blank)
(if applicable) - Person 2, name: (otherwise, leave blank)
(if applicable) - Person 2, relationship to child: (otherwise, leave blank)
(if applicable) - Person 2, cell phone and alternative phone: (otherwise, leave blank)
(if applicable) - Person 3, name: (otherwise, leave blank)
(if applicable) - Person 3, relationship to child: (otherwise, leave blank)
(if applicable) - Person 3, cell phone and alternative phone: (otherwise, leave blank)
(if applicable) - Person 4, name: (otherwise, leave blank)
(if applicable) - Person 4, relationship to child: (otherwise, leave blank)
(if applicable) - Person 4, cell phone and alternative phone: (otherwise, leave blank)
(if applicable) - Person 5, name: (otherwise, leave blank)
(if applicable) - Person 5, relationship to child: (otherwise, leave blank)
(if applicable) - Person 5, cell phone and alternative phone: (otherwise, leave blank)
(if applicable) - Person 6, name: (otherwise, leave blank)
(if applicable) - Person 6, relationship to child: (otherwise, leave blank)
(if applicable) - Person 6, cell phone and alternative phone: (otherwise, leave blank)
(if applicable) - Person 7, name: (otherwise, leave blank)
(if applicable) - Person 7, relationship to child: (otherwise, leave blank)
(if applicable) - Person 7, cell phone and alternative phone: (otherwise, leave blank)
Submit
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