Carroll High School
HIGH SCHOOL REGISTRATION FORM
Email *
Expected Grade Level *
Required
Enrollment Date
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DD
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Last Name: *
First Name: *
Middle Name: *
Social Security Number: *
Date of Birth: *
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Age: *
Gender: *
Required
Ethnicity *
Required
Street Address: *
City: *
Zip Code: *
Home Phone Number: *
Cell Phone Number: *
Emergency Contact: *
Emergency Contact Phone Number: *
SCHOOL HISTORY
Diploma Pathway *
Required
Last School Attended: *
Contact Person: *
Drop Date: *
MM
/
DD
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Address: *
City: *
State: *
Phone: *
*
Has student ever been enrolled in MCS before? If so, when and where? *
Special Services: *
Required
504 *
Is the IEP/IAP current? *
Required
PARENT/GUARDIAN INFORMATION
Student Lives with: *
Required
Primary Guardian Name *
Primary Guardian Cell Phone: *
Primary Guardian Email: *
Mother: *
Father: *
The information on this registration form is correct to the best of my knowledge. *
Required
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