New Student Registration Form- Clinton High School, includes Biographical, Health and Emergency, Home Language Survey
Section 1- Student Biographical Information -Verification Report.  Please be sure to fill out Section 2-Emergency Contacts
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Email *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Student lives with *
Student is a foster child *
Student Last Name *
Student Middle Name (if no middle name enter NMN) *
Student First Name *
Resident Street Address, town, zip code *
Mailing Address (If different from street address is it is the same please enter "same") *
Student Date of Birth *
MM
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DD
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YYYY
Place of Birth- REQUIRED  City, State, Country *
Parent/Guardian work information-name, address, phone number *
Student Email Address *
Primary Language Spoken at Home *
Is this the child's first year attending a US school *
Student's Ethnicity *
Student's race *
Is your child receiving special need services? *
Is your child currently a school choice student? *
Is your child currently receiving free or reduced lunch? *
Iparent Data- How many siblings does this student have attending any of the Clinton Public Schools? *
Names and grade levels of all siblings attending Clinton Public Schools- *
Student Health and Emergency Information Form
This information is required for the School Nurse
Physician name and phone number *
Health Insurance Company Name *
Health Insurance Policy Number *
Dental Insurance Company Name *
Dental Insurance Policy Number *
Please list any/all allergies *
Describe your child's allergic reaction
Please check off any health information that applies to your child *
Required
Any Vision/Hearing concerns? *
Does your child wear glasses/contacts? *
Does your child wear hearing aids? *
Please list any medications your child currently takes *
I allow my child to use hand sanitizer to disinfect hands during the school day *
CHS- I give the school nurse permission to Ibuprofen or Acetaminophen four times (2 times in a month) during the school year, Oragel, Tums, and first aid topical applications. *
I give permission to the school nurse to share information relevant to my child's health condition with appropriate school personnel when needed to meet my child's health and safety needs .   I give permission to exchange information with my child's primary care physician for the purpose of referral, diagnosis, and treatment.                                                                                                Electronic Signature by typing name below: *
Clinton Public School Home Language Survey
This form is required by MA DESE to determine the language spoken in each student's home to identify their specific language needs.
What us the native language of the student's mother/guardian?  Father/guardian? *
What language(s) are spoken at home with your child? *
What language did your child first understand and speak? *
What language do you use most with your child? *
What other languages does your child know? Please indicate if they can they speak, read, and/or write them. *
Will you require written information from school in your native language? *
Will you require an interpreter/translator at Parent-Teacher meetings? *
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