Crescent Middle School Enrollment
2021-2022
STUDENT LEGAL NAME *
PEFERRED NAME
Grade going into 2020-2021
SOCIAL SECURITY NUMBER *
GENDER
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BIRTHDAY & PLACE OF BIRTH *
ETHNICITY (If Native American please fill out title IX form.)
IS A LANGUAGE OTHER THAN ENGLISH USED IN YOUR HOME? (If yes please fill out language form)
PHYSICAL ADDRESS *
MAILING ADDRESS (If different from physical address) *
HOME PHONE NUMBER (THIS IS THE NUMBER THE AUTOMATED SYSTEM WILL CALL FOR ANNOUNCEMENTS.) *
EMAIL ADDRESS *
CURRENT MEDICATIONS
ALLERGIES (PLEASE PROVIDE PROPER MEDICATION/EPI PEN FOR STUDENT AND CARE PLAN FROM DOCTOR FOR MEDS AND ALLERGIES.) *
SPECIAL NEEDS
LEGAL ALERTS (PLEASE PROVIDE PROPER DOCUMENTS FOR LEGAL ALERTS)
PARENT 1: NAME, CELL PHONE & WORK PHONE *
PARENT 2: NAME, CELL PHONE & WORK PHONE *
EMERGENCY CONTACT (NAME, RELATIONSHIP & PHONE NUMBERS) *
SCHOOL LAST ATTENDED / CITY, STATE / PHONE & FAX (WAS CHILD SUSPENDED OR EXPELLED? YES OR NO IF YES, PLEASE EXPLAIN)
CLINIC CARD: __________________________________, THE PARENT WITH CUSTODY OR LEGAL GUARDIAN OF ______________________, WHO ATTENDS CRESCENT PUBLIC SCHOOLS. IF THIS CHILD IS INJURED OR BECOMES ILL AT SCHOOL, I HEREBY AUTHORIZE THE SCHOOL INSTRUCTOR, NURSE, SCHOOL TEACHER, OR PRINCIPAL TO ADMINISTER NON-PRESCRIPTION MEDICINE TO MY CHILD. THE ONLY NONPRESCRIPTION MEDICINE MAINTAINED IN THE SCHOOL OFFICE ARE ACETAMINOPHEN AND ANTACIDS. (ADD NAMES AND DATE IN THE ANSWER SECTION)
CORPORAL PUNISHMENT: IT IS THE POLICY OF THE CRESCENT BOARD OF EDUCATION TO ADMINISTER CORPORAL PUNISHMENT ONLY AS A LAST RESORT AFTER OTHER REASONABLE CORRECTIVE MEASURES HAVE BEEN USED WITHOUT SUCCESS. CORPORAL PUNISHMENT MUST BE ADMINISTERED BY THE ADMINISTRATOR IN THE PRESENCE OF ANOTHER STAFF MEMBER. CORPORAL PUNISHMENT WILL BE CONSIDERED AS A FORM OF DISCIPLINE FOR YOUR CHILD UNLESS A PARENT REQUEST OF DENIAL IS ON FILE.
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PEOPLE WHO CAN PICK UP CHILD
BUS NUMBER
MAY CHILD WALK HOME
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ANYTHING TEACHER NEEDS TO KNOW ABOUT STUDENT:
PERMISSION SLIP FOR HEARING AND VISION SCREENING: CRESCENT SCHOOLS HAS PERMISSION TO CHECK MY CHILD’S HEARING AND VISION DURING THE SCHOOL YEAR IF YOU SUSPECT THERE MAY BE A PROBLEM.
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THERE MAY BE TIMES OR EVENTS WHEN YOUR CHILD’S PICTURE AND/OR NAME MAY HAVE THE OPPORTUNITY TO BE USED ON THE INTERNET (CRESCENT SCHOOL WEB PAGE). WE ARE REQUIRED TO HAVE THE PARENT’S OR GUARDIAN’S PERMISSION BEFORE THEY CAN BE PLACED ON THE SCHOOL’S WEB PAGE. PLEASE SELECT YOUR CHOICE BELOW.
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