CPS Registration Form
You must complete a separate form for each child you are registering.
This registration is for what school year? *
For what grade are you registering your child? *
Student Information
LEGAL first name (as it appears on child's birth certificate) *
Your answer
LEGAL last name (as it appears on child's birth certificate) *
Your answer
Middle name
Your answer
Gender *
Child's Age *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Place of Birth - City and State *
(include Country if not USA)
Your answer
US Entry Date (if applicable)
MM
/
DD
/
YYYY
PREVIOUS SCHOOL INFORMATION
Previous School
Your answer
City/State of Previous School
Your answer
Previous School Grade
Does student have an IEP? *
(receives Special Education services)
Does student have a 504 Plan? *
(receives Special Education services)
Has this child previously attended Cranston Public Schools? *
If yes, please select the most recent CPS school that your child has attended.
Name of School
Race and Ethnicity
New Federal and state regulations require that all school districts in Rhode Island use a two-part question to collect data about students' race and ethnicity. Please answer BOTH of the questions which follow!
Is your child Hispanic or Latino? *
What is your child's race? *
Choose one or more
Required
GUARDIAN HOUSEHOLD INFORMATION-PRIMARY STUDENT RESIDENCE
Student Lives With: *
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
This person should be the adult parent /guardian with whom the student resides.
Your answer
Parent/Guardian Date of Birth *
MM
/
DD
/
YYYY
Relationship to Student *
Household Street Address *
Your answer
Household City *
Your answer
Household Zip Code *
Your answer
Primary Phone (robocalls) *
This is the phone number that you would want the school department to use to contact you in the case of an emergency, attendance calls, or other school department calls. (xxx)xxx-xxxx
Your answer
Robocall Language *
This is the language for the robocall messages.
Required
Parent/Guardian Email Address *
The registration packet will also be sent to this is the email address, so please make sure it is correct.
Your answer
2nd Parent/Guardian First Name
Your answer
2nd Parent/Guardian Last Name
Your answer
2nd Parent/Guardian Date of Birth
MM
/
DD
/
YYYY
2nd Guardian Relationship to Student
2nd Guardian Household Street Address
(if not residing with student)
Your answer
2nd Guardian Household City
Your answer
2nd Guardian Household Zip Code
Your answer
2nd Guardian Primary Phone
Your answer
2nd Guardian Email Address
Your answer
Sibling 1- Full Name
Your answer
Sibling 1- Date of Birth
MM
/
DD
/
YYYY
Sibling 2- Full Name
Your answer
Sibling 2- Date of Birth
MM
/
DD
/
YYYY
Sibling 3- Full Name
Your answer
Sibling 3- Date of Birth
MM
/
DD
/
YYYY
RI Department of Education Home Language Survey
What language do you use most often when speaking to your child? *
What language did your child first learn to speak? *
What language does your child use most often when speaking to you? *
What language does your child use most often when speaking to other adults in the home or to their primary caretaker? *
What language does your child use most often when speaking to siblings or other children in the home? *
What language does your child use most often when speaking to friends or neighbors outside the home? *
Medical Information
Medical Doctor or Clinic Name
Your answer
Medical Doctor or Clinic Phone
(xxx)xxx-xxxx
Your answer
Medical Doctor or Clinic Address
Please include Street Address, City, State and Zipcode
Your answer
Date of Child's last physical examination
MM
/
DD
/
YYYY
Child Requires Use of the Following
Allergies
Please check any that apply.
Please list the allergies:
Your answer
If your child takes medicine for allergies or allergic reactions, please explain:
Your answer
Medical History
Please check any of the following diseases or conditions that apply to your child
PLEASE LIST AND DESCRIBE ANY HOSPITALIZATIONS, SURGERIES, OR SERIOUS ILLNESS OR INJURY:
Your answer
MEDICATIONS:
Please list any medications your child is currently taking.
Your answer
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