ECPS Required *HS Student Info. Forms '20 - '21
Email address *
Student's Last Name *
Student's First Name *
Student's Date of Birth *
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DD
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Primary Parent or Guardian's Name: *
Primary (1st) Parent or Guardian Relationship to child: *
Primary (1st) Parent or Guardian Phone Number: *
Primary (1st) Parent Email Address:
2nd Parent or Guardian's Name:
2nd Parent or Guardian's Relationship to child:
2nd Parent or Guardian Phone Number
2nd Parent or Guardian Email
3rd Contact for Emergency or Pick Up - Name:
3rd Contact for Emergency or Pick Up - relationship to student:
3rd Contact for Emergency or pick Up - Phone Number:
4th Contact for Emergency or Pick Up - Name:
4th Contact for Emergency or Pick Up - relationship to student:
4th Contact for Emergency or pick Up - Phone Number:
Any special instructions we need to be aware of regarding pick-up of your child?
Any special instructions we need to be aware of regarding your child's health? (conditions, allergies, regular medications)
Student's physical address:
Student's mailing address (if different):
City
Zip Code
Transfer Information: Do you and the above student live in the Elmore City - Pernell School District? *
Do you plan on moving within the school year?
Select one or more of the following races. *
Required
Student's grade for the '20-'21 school year *
Does your child have an IEP (Individualized Education Plan)?
ELECTIVE COURSES. Please select your top (1st) choice. Asterisk(*) means you must have already taken a prerequisite course or you must have administrative approval. Understand, you may not get all of your choices but we will try our best to accommodate you.
ELECTIVE COURSES. Please select your next (2nd) choice. Asterisk(*) means you must have already taken a prerequisite course or you must have administrative approval. Understand, you may not get all of your choices but we will try our best to accommodate you. Do not select a previously chosen elective.
ELECTIVE COURSES. Please select your third (3rd) choice. Asterisk(*) means you must have already taken a prerequisite course or you must have administrative approval. Understand, you may not get all of your choices but we will try our best to accommodate you. Do not select a previously chosen elective.
ELECTIVE COURSES. Please select your fourth (4th) choice. Asterisk(*) means you must have already taken a prerequisite course or you must have administrative approval. Understand, you may not get all of your choices but we will try our best to accommodate you. Do not select a previously chosen elective.
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