Jr. High/High School Enrollment: New Student Online Form
Enrollment for school year: 2026/2027
There will be additional required forms, schedules, and signatures at in person enrollment
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Email *
Full name (First, Middle, Last) *
Full physical address (Address, city, state, zip code) *
Mailing Address (address, city, state, zip code) *
Social Security Number *
Grade *
Sex *
Required
Date of Birth *
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Place of Birth *
National Origin (check all that apply) *
Required
Does your child have Native American Heritage? *
If yes to above question, please list a specific tribe. Be prepared to send in copy of Tribal Memebership *
Father's Name *
Father's Phone Number *
Father's Email *
Mother's Name *
Mother's Phone Number *
Mother's Email *
1st Emergency Contact Name and Relationship *
1st Emergency Contact Phone Number *
2nd Emergency Contact Name and Relationship *
2nd Emergency Contact Phone Number *
Would you like to be enrolled in the Cement Public Schools Parent Notification System? *
If Yes to the above question,  please give email and phone number you would like to receive notifications to
What school did your child previously attend? *
Was your child enrolled in Special Education? *
Was your child enrolled in 504 plan? *
Was your child enrolled in special math or reading class? *
Was your child enrolled in speech, OT, PT? *
May the school use corporal punishment as a form of discipline on your child? *
What is the dominant language most often spoken in the home, regardless of the language spoken by the student *
I understand and will abide by the District's terms and conditions with regard to the Internet Access Conduct Agreement. *
Required
I understand and will abide by the District's terms and conditions with regard to the Wireless Telecommunication Devices Rules and Permission Form. *
Required
I understand and will abide by the District's terms and conditions with regard to the Privacy Release of Name and/or Likeness *
Required
Will your Child be riding the bus *
If yes to above question, please indicate address of bus stop 
Does your child take any type of medication that the school should be aware of? If yes, other documentation will need to be filled out. *
I do here authorize officials of the Cement School district to contact directly the persons named as contacts on my child's enrollment forms and do authorize the named physicians to render such treatment as may be deemed necessary in an emergency of the health of said child. In the event parents, physicians, or other persons named on this enrollment form cannot be contacted, the school officials are hereby authorized to take whatever action is deemed necessary in their judgement, for the health of the aforesaid child. I will not hold the school district financially responsible for the emergency care and/or transportation for said child.  *
I hereby authorize the Oklahoma Immunization Service to release my Immunization records and information located within the Oklahoma State Immunization Information System to Cement Public schools for my child's shot record *
I, the student, have reviewed the Cement Public Schools Handbook for the 2026-2027 school year. The contents of the handbook (including information on attendance, discipline, bus policy, extracurricular activities, acceptable use of technology, and rights under FERPA) have been reviewed. I understand my rights and responsibilities as a student enrolled at Cement Public Schools. *
I acknowledge I have reviewed the contents of the handbook with my student. In addition, I have reviewed on the schools website (or obtained and read a copy from the school) the listing of extracurricular activities available to my child.  *
Name of parent or guardian completing  this form and authorizing the enrollment of the above named child at Cement Public Schools for the indicated school year: *
Date of Completion *
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