CHS Student Online Registration and Forms
You may use this online form to update your beginning of the year registration information packet for the 2021-2022 school year. New students to the district will still need to complete required paperwork with the office.

If you have any questions you may visit our website:  https://chs.clintonsd.org/
Or call 501-745-6000.
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Student Last Name *
Student First Name *
Student Middle Name *
Student grade for the 2021-22 school year *
Student Learning Method *
Do you have quality internet service at your primary home? *
Do you have a strong cellular signal at your home? *
Student Address including City, State, and Zip code * *
Parent/Guardian #1 Name *
Does the student primarily reside with this Parent/Guardian? *
Parent/Guardian #1 Phone Number (###) ###-#### *
Parent/Guardian #1 Email Address *
Parent/Guardian #1 Address including City, State, and Zip code *
Parent/Guardian #1 Employer and Phone Number *
Parent/Guardian #2 Name
Does the student primarily reside with this Parent/Guardian?
Clear selection
Parent/Guardian #2 Phone Number (###) ###-####
Parent/Guardian #2 Email Address
Parent/Guardian #2 Address including City, State, and Zip code
Parent/Guardian #2 Employer and Phone Number
Emergency Contact Name *
Emergency Contact Phone Number (###) ###-#### *
Emergency Contact Email Address *
Emergency Contact Address including City, State, and Zip code *
Emergency Contact Employer and Phone Number *
How will the student travel to school? *
How will the student travel from school? *
Does your child take any medicine at home or at school on a regular basis. If yes, state the name of the medication, time given, and reason for the medication. *
Does your child have any health problems that would limit or affect his/her activities at school or participation in PE. If yes, please explain. *
Does the student have health insurance? *
Preferred physician and phone number? *
Preferred dentist and phone number? *
Does the student have or had the following? *
Yes
No
Chicken Pox
Allergies
Bee Sting Allergy
Asthma
Diabetes
Seizures
Heart Condition
Bone/Joint Problems
If yes to any above, please describe the issues.
Does your child have other health concerns. Check all that apply. *
Required
If yes to any of the above health concerns, is there more detailed information we need to know?
Please list the names of anyone who is NOT allowed to check out/pick up this student from school. *
Please list any siblings in Clinton Schools (Name and Grade) *
I have received an electronic copy of the school handbook.  https://chs.clintonsd.org/159275_2 *
Clinton School District policy still allows for corporal punishment as an option for school discipline. Please select your choice below. *
I agree to the school internet use and electronic device use agreements. The documents can be read on page 81 at: https://chs.clintonsd.org/159275_2 *
I agree for my child to be subject to random drug testing in the Clinton School District. I realize that this is required for participation in any extracurricular activity. Read the policy in full on page 91 at: https://chs.clintonsd.org/159275_2
Clear selection
Objection to Physical Examinations or Screenings: I hereby note my objection to the screening of my child for the following physical examinations: (check all that apply) *
Required
Objection to Publication of Directory Information: I object and wish to deny the disclosure or publication of directory information to the follow. Check all that apply. *
Required
Permission to Display photo of student on website: I hereby grant permission to the Clinton School District to display the photograph or video clip of my student on the District's web site, including any page on the site, or in other District publications without further notice. I also grant Clinton School District the right to edit the photograph or video clip at its discretion. The student's name may be used in conjunction with the photograph or video clip. It is understood, however, that once the photograph or video clip is displayed on the web site, the District has no control over how the photograph or video clip is used or misused by persons with computers accessing the District's web site. * *
Residency Information: Is the address you provided Temporary or Permanent? *
Residency Information: Please choose which of the following situations your child/your family currently lives in (you can choose more than one): *
Required
Residency Information: If you are living in shared housing, please check all of the following reasons that apply:
Residency Information: If you chose other in the above listing, please explain below.
Residency Information: Are you a student under the age of 18 and living apart from your parents or guardians? *
Has your family moved across a school district line within the past 3 years to look for or do any of the following jobs: meat processing, farm work, cotton gin, cutting or planting trees, fish farming, harvesting fruits or vegetables, working at a granary, other agricultural work? *
By typing my name below, I am electronically signing my child's registration packet for the 2020-2021 school year. I also certify that the information given above it true and correct. *
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