SB Enrollment Form
Please fill in the information below as completely as possible checking for errors along the way.
Required student information
Student's Last Name *
Student's First Name *
Gender *
Grade Level
Physical Street Address *
Ex. 123 N Abc St.
City *
State *
Zip *
Primary Phone Number
This is the phone number we will try first when contacting you.
Secondary Phone Number
This is the second number we will try before moving on to your emergency contacts.
Mailing Street Address
This is the address where your mail is delivered.
Mailing City
Mailing State
Clear selection
Mailing Zip
Is the student Hispanic/Latino?
Clear selection
Date of Birth *
MM
/
DD
/
YYYY
Country of Birth if other than the United States
Leave this field blank unless your student was born outside of the USA
What county does the student live in? *
Race
Please check all that apply
Date entering South Barber school
NEW STUDENTS ONLY
MM
/
DD
/
YYYY
Primary Physician
Physician Location
Ex: Kiowa Clinic
Physician Phone
If other than local clinic
Last School and District Attended
NEW STUDENTS ONLY: Please be as specific as possible as this information is used to obtain student records. If student has never attended a school enter N/A.
Address of last school
NEW STUDENTS ONLY: City and State at a minimum
Phone number of last school
NEW STUDENTS ONLY
Last date of attendance
NEW STUDENTS ONLY
MM
/
DD
/
YYYY
Does the Student have an Individualized Education Plan (IEP)? *
If yes, If other than the previous school attended, where may IEP information be obtained?
Name, Address and Phone number.
Is the student in foster care? *
If yes, please enter the name and phone number of case worker.
Mother's Information
Name
Employer
Primary Phone Number
The first number you want us to call when contacting you.
Secondary Phone Number
The second number you want us to call when contacting you.
Email Address for School Notifications
If you would like to be added to our school notification email list (school closings, major schedule changes, etc.) please input your email address below. This only needs to be done ONCE per family.
Father's Information
Name
Employer
Primary Phone Number
The first number you want us to call when contacting you.
Secondary Phone Number
The second number you want us to call when contacting you.
Email Address for School Notifications
If you would like to be added to our school notification email list (school closings, major schedule changes, etc.) please input your email address below. This only needs to be done ONCE per family.
Emergency Contact Person 1 Information
This is the first person we should call if we cannot get contact the student's mother or father during an emergency.
Name
Primary Phone Number
Secondary Phone Number
Relationship to student
Emergency Contact Person 2 Information
This is the second person we should call if we cannot get contact the student's mother or father during an emergency.
Name
Primary Phone Number
Secondary Phone Number
Relationship to student
Report Card
Report Card mailed to second address? *
Such as another parent/guardian.
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