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Franklin School Of Opportunity Grade 1-5 Online Program
Lakewood City Schools
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Registration Form 2021-2022
Student Name (First Name) ( Last Name)
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Student ID Number (for current Lakewood students only)
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Grade
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Kindergarden
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Gender
Female
Male
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Student Birthdate
MM
/
DD
/
YYYY
Current IEP
Yes
No
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Current 504 Plan
Yes
No
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ESL Services
Yes
No
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Has student ever been suspended or expelled?
Yes
No
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Is student eligible for the free & reduced lunch program?
Yes
No
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Health (Check all that apply)
Severe Allergy
Diabetes
Epi-Pen
Asthma
Seizure Disorder
Medications
Other:
Native / Primary Language
English
Other:
Parent/Guardian(s) Name (First Name)(Last Name)
Your answer
Address
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Current Email
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Other Email
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Home Phone Number
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Work Number
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Cell Number
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Emergency Contact 1 Name (First Name) (Last Name)
Your answer
Emergency Contact 1 Phone Number
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Emergency Contact 2 Name (First Name) (Last Name)
Your answer
Emergency Contact 2 Phone Number
Your answer
Student Lives With (Check all that apply)
Mother
Father
Step-Parent
Grandparent
Guardian
Other:
Legal Custody (Check all that apply)
Mother
Father
Grandparent
Guardian
Other:
Previous/Home Building (for current Lakewood students only)
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Previous District/School (for students NOT currently enrolled in Lakewood City Schools)
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Last Date Attended
MM
/
DD
/
YYYY
Additional Notes:
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