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 *
Your answer
Student's First Name *
Your answer
Gender *
Grade Level
Social Security Number
xxx-xx-xxxx
Your answer
Physical Street Address *
Ex. 123 N Abc St.
Your answer
City *
Your answer
State *
Zip *
Your answer
Primary Phone Number
This is the phone number we will try first when contacting you.
Your answer
Secondary Phone Number
This is the second number we will try before moving on to your emergency contacts.
Your answer
Mailing Street Address
This is the address where your mail is delivered.
Your answer
Mailing City
Your answer
Mailing State
Mailing Zip
Your answer
Is the student Hispanic/Latino?
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
Your answer
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
Your answer
Physician Location
Ex: Kiowa Clinic
Your answer
Physician Phone
If other than local clinic
Your answer
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.
Your answer
Address of last school
NEW STUDENTS ONLY: City and State at a minimum
Your answer
Phone number of last school
NEW STUDENTS ONLY
Your answer
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.
Your answer
Is the student in foster care? *
If yes, please enter the name and phone number of case worker.
Your answer
Mother's Information
Name
Your answer
Employer
Your answer
Primary Phone Number
The first number you want us to call when contacting you.
Your answer
Secondary Phone Number
The second number you want us to call when contacting you.
Your answer
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.
Your answer
Father's Information
Name
Your answer
Employer
Your answer
Primary Phone Number
The first number you want us to call when contacting you.
Your answer
Secondary Phone Number
The second number you want us to call when contacting you.
Your answer
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.
Your answer
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
Your answer
Primary Phone Number
Your answer
Secondary Phone Number
Your answer
Relationship to student
Your answer
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
Your answer
Primary Phone Number
Your answer
Secondary Phone Number
Your answer
Relationship to student
Your answer
Report Card
Report Card mailed to second address? *
Such as another parent/guardian.
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