Northwest Elementary Online Registration Form for 2021-2022 School Year
Please complete the following registration survey for any child that you wish to attend Northwest Elementary for the 2021-2022 academic school year. **

Kindergarten Parents: Children must turn 5 years old by September 30, 2021. Submitting this form is just the first step in the registration process. You must also provide copies of your child's birth certificate, social security card, immunization records and custody papers (if applicable).

Choose one of these many different ways you can submit your documents required for enrollment:
1) Take a picture of your document and email it directly to
2) Use the Notes app on an iPhone to scan and email documents to (Learn
how at
3) If you have a Google account, you can upload your income forms at
4) Bring your documents to the school and we will make a copy to keep for our records.

Preschool Parents: STOP!! Please do not complete this form until you have submitted the REQUIRED NORTHWEST PRESCHOOL APPLICATION (found under the Parents tab on the NLSD web page), been accepted into the program, and have been instructed to fill out this form. Children should turn 4 years old by September 30, 2021 and be potty-trained for the Northwest ECE Preschool Program.

If you would rather not use this form to submit your information, you have other options. Give us a call or email and let us know what method works best for you.
1) Email Mrs. Shannon ( or Mrs. Sissel (
2) Call 740-259-2250, choose option 7 or extension 3300, leave a message, and your call will be promptly returned.

**The information collected through this form will only be sent to those individuals authorized by the district to access confidential information.
I am completing this survey for a child entering _____________ for the 2021-22 Academic School Year *
Child's First Name *
Child's Middle Name *
Child's Last Name *
Child's Preferred Name
Child's Date of Birth *
Child's City and State of Birth *
If the child was born outside of the United States, what country was he/she born in and is his/her native language English? If not, list native language.
Biological Mother's Maiden Name *
Gender of Student *
Child's Ethnicity *
School District of Residence *
Street Address of Residence and P.O. Box if applicable *
City of Residence *
State of Residence *
Zip Code *
County of Residence *
Telephone number *
Additional telephone number *
Email Address
Legal Parent(s)/Guardian(s) *
Relationship of Legal Parent(s)/Guardian(s) to child *
Parent(s)/Guardian(s) are... *
Are there any papers on file in Juvenile Court with regard to this child's custody? (Divorce papers, Powers Of Attorney, temporary or legal custody orders,etc.). If so, briefly describe. *
Biological Father's First and Last Name. Also list his address only if different from the child's address. *
Biological Mother's First and Last Name. Also list her address only if different from the child's address. *
Is the child a dependent of a member of the Active Duty Forces? *
Is the child a dependent of a member of the National Guard? *
Does this child have any siblings currently attending the Northwest School District? If so, please list name and grade. *
Has this child ever repeated a grade in school? If yes, which grade? *
Does your child have an IEP ? (Individualized Education Program) *
Has your child ever received or been evaluated for special education services? *
If your child is transferring to our school, please list the Name, City and State of the last school attended. If the child is new to Kindergarten or Preschool, just leave blank. *
If you recently moved into the Northwest School District, please list your previous address.
List any other adults to whom your child may be released, their relationship to the child and their contact information. *
Do you wish for your child to ride a yellow school bus? *
List any characteristics relating to the health and/or personality of your child that may help teachers, nurses, bus drivers and other staff members better understand your child.
Name of person submitting this form and relationship to the child. *
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