WES Student Registration/Emergency Contact Form
Student Name (First, Middle & Last) *
Date of Birth *
Place of Birth *
Gender *
Age *
Grade *
Please choose one *
Mailing Address *
Street Address *
Is English the native language? *
Is there a second language spoken at home? *
1. Parent information
Parent: Please indicate by checking below: *
Required
First & Last Name: *
Employer (if not employed, please state that) *
Address *
Home phone: (if no home phone, please state N/A) *
Cell Phone: (if no cell phone, please state N/A) *
Work phone: (if no work phone, please state N/A) *
Email address *
Parent/Guardian in the U.S. Military or National Guard *
2. Parent Information:
Parent: Please indicate by checking below *
Required
First & Last Name *
Employer: *
Address: *
Home Phone: (if no home phone, please state N/A) *
Cell phone: (if no cell phone, please state N/A) *
Work phone: (if no work phone, please state N/A) *
Email address: *
Parent/Guardian in the U.S. Military or National Guard? *
Parents marital status: *
Required
Are there any court orders the school needs to be aware of? *
Child is currently living with: *
Required
Please list the names & ages of any siblings: *
Has the child received any of the following services? *
Required
Last school attended was? *
Will the child be bused to school? *
If your child will be bused to school, what bus #? (if you are not sure of the bus number, please state that)
Will the child be bused from school? *
If your child will be bused from school, what bus #? (if you are not sure of the bus number, please state that)
Name of person with whom your child may leave school if you cannot be reached:
Emergency Contact information
Name of Emergency Contact #1 *
Emergency Contact #1 Relationship *
Emergency Contact #1 Home Phone number (if no home phone, please state N/A): *
Emergency Contact #1 Cell phone number (if no cell phone, please state N/A): *
Emergency Contact #1 Work phone number (if no work phone, please state N/A): *
Name of Emergency Contact #2: *
Emergency Contact #2 Relationship *
Emergency Contact #2 Home Phone number (if no home phone, please state N/A): *
Emergency Contact # Cell Phone number (if no cell phone, please state N/A): *
Emergency Contact #2 Work Phone number (if no work phone, please state N/A): *
Date of completion of this form: *
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This form was created inside of School Administrative Unit # 23. Report Abuse