SESE Classroom Student Enrollment 2025-2026

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Student's First Name *

Student's Last Name *

Student's Date of Birth *

YYYY

Student's Home Street Address *

Student's Home City, State Zip Code *

Example: Anytown, IL 61234

Student's Home Phone Number *

Example: 618-123-4567 If you do not have a home phone number, please enter NA.

Parent 1's/Guardian 1's Name *

Please enter first and last name or enter NA if not applicable.

Parent 1's/Guardian 1's Cell Phone Number *

Example: 618-123-4567 If you do not have a cell phone number, please enter NA.

When is a convenient time to contact Parent 1/Guardian 1?

Anytime

Morning (8:00 am - 11:59 am)

Afternoon (12:00 pm - 4:59 pm)

Evening (5:00 pm - 8:30 pm)

Other:

Clear selection

Parent 1's/Guardian 1's Address *

If same as above, check box. If different, please list below with the City, State and Zip Code included or list NA if not applicable.

Same as Student's Address

Other:

Parent 1's/Guardian 1's Email Address *

If you do not have an email address, please enter NA.

Parent 1's/Guardian 1's Employer *

If you do not have an employer, please enter NA.

Parent 1's/Guardian 1's Employer's Phone Number *

Example: 618-123-4567. If you do not have an Employer's phone number, please enter NA.

Parent 2's/Guardian 2's Name *

Please enter first and last name or enter NA if not applicable

Parent 2's/Guardian 2's Cell Phone Number *

Example: 618-123-4567 If you do not have a cell phone number, please enter NA.

When is a convenient time to contact Parent 2/Guardian 2?

Anytime

Morning (8:00 am - 11:59 am)

Afternoon (12:00 pm - 4:59 pm)

Evening (5:00 pm - 8:30 pm)

Other:

Clear selection

Parent 2's/Guardian 2's Address *

If same as above, check box. If different, please list below with the City, State and Zip Code included or enter NA if not applicable.

Same as Student's Address

Other:

Parent 2's/Guardian 2's Email Address *

If you do not have an email address, please enter NA.

Parent 2's/Guardian 2's Employer *

If you do not have an employer, please enter NA.

Parent 2's/Guardian 2's Employer's Phone Number *

Example: 618-123-4567. If you do not have an Employer's phone number, please enter NA.

Approved Individual (1) to Pick-up Student *

Someone other than Parent/Guardian

Approved Individual (1)'s Phone Number *

Example: 618-123-4567

Approved Individual (2) to Pick-up Student *

Someone other than Parent/Guardian

Approved Individual (2)'s Phone Number *

Example: 618-123-4567

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