Enrollment Data Form
Please fill out one per child that you have enrolled at Rock County Public Schools. Please be sure to fill this form out in it's entirety and click submit to be sure we received your enrollment form.
Which RCPS school will your child be attending? *
Student's Full Legal Name: *
Gender *
Date of Birth: *
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Grade Entering: *
Student's Preferred Name:
Race: *
Has student ever attended a Nebraska public school? *
Sibling(s) currently attending RCPS: *
Mailing Address, including City, State, Zipcode: *
Home Phone: *
County of Residence: *
Last school attended (only for those who have not attended RCPS previously):
Please list any special services that the student receives:
Custodial Parent/Guardian Full Names: *
Custody: *
Student lives with: (If the family has a domestic relations order governing custody or care of the child, we must have a copy of this order or parenting plan. If for any reason the non-custodial parent is not allowed visitation rights and does not have the right to remove the student from school, we must have a legal document from the custodial parent to support this order. *
Father's Contact Information: (Please include cell phone and any additional numbers he can be reached at)
Mother's Contact Information: (Please include cell phone and any additional numbers she can be reached at)
Father's Work Place: (please include work phone number)
Mother's Work Place: (please include work phone number)
Mother's Email Address:
Father's Email Address:
Student Cell Phone Number: (Please note, this is optional to share with us)
Emergency Medical Conditions/Problems of Student: (check all that apply) *
Required
Person to call if Parent/Guardian cannot be reached: Emergency Contact 1 - (Name/Relationship to Child/Phone) *
Person to call if Parent/Guardian cannot be reached: Emergency Contact 2 - (Name/Relationship to Child/Phone)
Person to call if Parent/Guardian cannot be reached: Emergency Contact 3 - (Name/Relationship to Child/Phone)
Permission is given for my child to attend any school related field trip in or out of town. (Parents/Guardians will be notified prior to any field trip as well.) *
Parent/Guardian Electronic Signature: *
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