Has this student ever attended one of the North Adams Public Schools PreK classes in the past? (Headstart is not considered part of NAPS PreK) *

If you answered YES, what school, and when? (Skip if you answered NO)

Has this student attended PreK at another Center-Based building? (Headstart, Monument Square, Williamstown PreK, etc.) If the answer is YES, please tell us the name and city/town of the PreK Program. (Skip this question if NO)

While we fully anticipate that the Fall School Year will be back to 5 full days of in-person learning, if that changes, do you prefer this student to enroll as "REMOTE ONLY" (Fully learning at home) or "HYBRID" (attending school in-person, part-time, remotely the rest)? *

IF we have to have some remote learning time in the fall, does this student already have a device to use at home during those remote learning times, or will a device need to be borrowed from the School District? *

Will this student require bus transportation, or will someone be dropping off/picking up from school? *

If you answered YES to needing bus transportation, please provide the address where your child will be picked up and dropped off (must be the same address for both - we cannot pick up and drop off at 2 different places)

We try to accommodate session preference for our families, though cannot guarantee it. Would you prefer your child to be in a morning (AM) session or an afternoon (PM) session? *

Student's FULL LAST Name *

Student's FULL FIRST Name *

Student's FULL MIDDLE Name (if no middle name please enter NMN) *

Student's Date of Birth *

Gender *

City or Town of Birth *

Student Ethnicity - Is this student Hispanic or Latino? *

Student Race: (Please check ALL that apply) *

Primary Home Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx) *

Physical Street Address *

City *

State *

Zip Code *

If you have a different MAILING address, please provide the street, city, state and zip code

Who does the student live with? Check the best answer, and then fill in the following parent contact information sections as applicable. (scroll down several places for Guardian information if student does not live with parents) *

Parent 1 or Mother's Name (Last, First)

Parent 1 or Mother's Full Address (if different from Student)

Parent 1 or Mother's Home Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx)

Parent 1 or Mother's Cell Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx)

Parent 1 or Mother's Daytime/Work Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx)

Parent 1 or Mother's Email Address

Parent 2 or Father's Name (Last, First)

Parent 2 or Father's Full Address (if different from Student)

Parent 2 or Father's Home Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx)

Parent 2 or Father's Cell Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx)

Parent 2 or Father's Daytime/Work Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx)

Parent 2 or Father's Email Address

If Student does not live with Parent(s), Name of Legal Guardian (Last, First)

Is this a foster care placement?

Legal Guardian's Full Address

Legal Guardian's Home Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx)

Legal Guardian's Cell Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx)

Legal Guardian's Daytime/Work Phone Number - PLEASE USE DASHES (xxx-xxx-xxxx)

Legal Guardian's Email Address

Are there any custody issues we need to be aware of? If YES, please explain below. (Legal documentation will be required) *

Does Student have any siblings that CURRENTLY attend North Adams Public Schools? *

If you answered YES, Please List Full Name(s) and Grade Level(s) of Sibling(s) who CURRENTLY attend North Adams Public Schools, or who you will be enrolling in addition to this student.

Please provide full names, phone numbers and relationship to this student, of AT LEAST 2 other Emergency Contacts - OTHER THAN PARENT(S)/GUARDIAN(S) - that the school may call if not able to contact you in an emergency to pick up your child. *

Academic Information: Please check ALL applicable boxes below, and be prepared to provide copies, if noted. *

Is this student involved with any other outside agencies? If YES, explain below.

Are there any behavioral concerns that may affect school progress? If YES, explain below.

Does your child have any allergies that the school needs to know about? (Foods, Latex, Insects, etc?)

NOTICE OF POSSIBLE PUBLICATION OF STUDENT INFORMATION: Do you give consent for your child's information to be publicized (such as awards, honors, school celebrations, etc. in the form of photos or written publications)? If you choose NO, you must provide the school with a written letter stating such, and NO information will be publicized about your child. If you choose YES, you are also (by law) consenting to Section 9528 (Armed Forces Recruiter Access to Students and Student Recruiting Information on the No Child Left Behind Act) which requires schools receiving assistance under the Elementary and Secondary Education Act of 1965 to provide students' names, addresses and telephone numbers to military recruiters when age required. *

MILITARY FAMILY STATUS (In compliance with the Massachusetts Valor Act) Please check all that apply. Is this student a child of: *

There are some additional documents we will need to complete enrollment, and you will be contacted for those separately. Do you have the ability to take a clear picture or scan/copy and email these documents to the school district? (Such as proof of residency documents, birth certificates, etc?) If you do not, other arrangements for submitting these documents will be made. *

By typing my name below, I certify that the responses provided are accurate and complete as specified by Massachusetts General Law. I understand that failure to disclose or to misrepresent any of the required information may result in my student's exclusion from North Adams Public Schools. I have read and understand the registration and residency requirements of North Adams Public Schools and I am aware that it is my obligation to inform my child's school if there is a change in the residency of my family or guardianship of my child. *

Relationship to child *