Milwaukee Seventh-day Adventist School
Student Registration Application
Date of Application *
Campus Applied for: *
Grade Entering *
Student's full legal name
Student's First Name *
Student's Middle Name
Student's Last Name *
Student's Street Address *
Student's City *
Student's State *
Student's Zip Code *
Child's Home Church *
Is your child baptized?
Clear selection
Year baptized
Student Age by September 1
K4 Must be 4

K5 Must be 5

1st Grade Must be 6
Current age *
Date of Birth *
Place of Birth *
Gender *
Ethnicity *
Race *
Previous School your child attended
School Name
School Address
School Street Address
School City
School State
School Zip Code
School Phone Number
Does your child have Special Education Needs? *
If yes, please explain Special Education Needs
Does your child have an IEP? *
Medical Information
Asthma or breathing problems *
If yes, does he/she use an inhaler?
Clear selection
Food allergies *
List Allergies
Any other allergies *
List all other allergies
Does your child use an EPI pen?
Is your child on medications? *
If yes, list medications
Does your child have any other health conditions? *
If yes, please explain health conditions
Available for North and South Campuses only with a monthly charge
How my child will travel to and from school *
Name of others that will transport my child
Parent/Guardian Information
Child lives with: *
Marital status of parent
Clear selection
Mail School correspondence to: *
Father's legal name:
Father's address if different from mother or child
Father's Street
Father's City
Father's State
Father's Zip Code
Father's E-mail address
Father's Home phone
Father's Cell phone
Father's Work phone
Is father SDA? *
Mother's legal name
Mother's address if different from father or child
Mother's Street
Mother's City
Mother's State
Mother's Zip Code
Mother's E-mail address
Mother's Home phone
Mother's Cell phone
Mother's Work phone
Is mother SDA? *
Legal Guardian's name
Relation to student
Guardian's address if different from parent or child
Guardian's Street
Guardian's City
Guardian's State
Guardian's Zip Code
Guardian's E-mail
Guardian's Home phone
Guardian's Cell phone
Guardian's Work phone
Is guardian SDA?
Clear selection
Other information needed for new students when applying
Original Birth Certificate (Will be returned)
A copy of your child's Immunization Records
Your child's most recent Assessment Test Results and Report Card
A copy of your child's IEP if applicable
By entering my name I certify that I completed this application, and that all information is true and correct.
First and Last name *
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