Appleton City Elementary Enrollment
2020 - 2021 Enrollment, Emergency Contact & Transportation
Email address *
Child's Full Legal Name: *
Grade: *
Student's Date of Birth *
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Student's Social Security Number
Nickname (if the child goes by something other than his/ her legal name)
House Number (where student resides): *
Street Direction
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Street Name / Road Number
City:
Zip Code:
County
Is the child living with their parent or legal guardian in someone else’s house other than your own, living with a friend or family member other than their parent/legal guardian; living at a shelter, at a hotel or motel, or in a vehicle or campground (unsheltered)?
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Ethnicity
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Race (check all that apply)
Do you use a language other than English?
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Is there any language other than English spoken in your home?
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Student's country of origin
Parent's country of origin
Date Entered the United States, if applicable
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Date entered school in the United States, if applicable
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Parent / Guardian 1 - Name
Is Guardian 1 in the home?
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Parent 1 - Address, if different than student's
Parent 1 - cell phone
Parent 1 - Employer
Parent 1 - work phone
Parent 1 - e-mail address
Parent 2 - Name
Is Parent 2 living in the home?
Clear selection
Parent 2 - Address, if different than student's address
Parent 2 - Cell phone number
Parent 2 - Employer
Parent 2 - Employer phone number
Parent 2 - e-mail address
Other Parent / Guardian living in the home - Name
Other Parent / Guardian - relationship to child
Other Parent / Guardian - Cell Phone
Other Parent / Guardian - Employer
Other Parent / Guardian - Employer phone number
Siblings: (who currently live in the Appleton City R-2 School District) - name(s), grade(s)
1st Alternate Emergency Contact Information - Name
1st Alternate Emergency Contact Information - Phone Number
1st Alternate Emergency Contact Information - Relationship
1st Alternate Emergency Contact Information - Do you authorize the district to release any and all identifiable information about your student to this person and to pick up your child on your behalf.
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2nd Alternate Emergency Contact Information - Name
2nd Alternate Emergency Contact Information - Phone Number
2nd Alternate Emergency Contact Information - Relationship
2nd Alternate Emergency Contact Information - Do you authorize the district to release any and all identifiable information about your student to this person and to pick up your child on your behalf.
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Is there anyone who is NOT to pick up your child from school or school events? If yes, please provide that person's name and any applicable details. Also, please provide any applicable court documents / custody papers to the school.
Is your child currently under suspension or expulsion from school?
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Has your child ever been under suspension or expulsion from school?
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If your child has ever been suspended or expelled from school, please state the reason(s)
Do you authorize Appleton City School District to send communications via test messages to the Parent / Guardian's cell phone numbers provided in this form?
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Transportation: How will your child get to school in the mornings?
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Transportation: How will your child get to school in the afternoons?
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In case of early release due to bad weather or other emergency how should your child go home, if your child should go home a different way than listed above? Please be specific :
Directory Information/Media Release: If you do not want Appleton City R-II School to disclose any or all of the types of information designated below as directory information from your child’s education records without your prior written consent, you must notify the Appleton City R-II School in writing by 10 days of receiving this form. Appleton City R-II has designated the following information as directory information: (Note: an LEA may, but does not have to, include all the information listed below.) Student’s name; address; telephone listing; e-mail address; photograph; date and place of birth; major field of study; dates of attendance; grade level; participation in officially recognized activities and sports; weight and height of member of athletic teams; degrees, honors, and awards received; the more recent educational agency or institution attended. Student photographs, names and special recognitions may also be published through the Appleton City School Facebook page, Twitter, Appleton City District Web page, Elementary School Newsletter and/or the Local Newspaper, unless the parent / guardian has notified the school of non-consent to do so. *
Field Trip Permission: At different times during the school year, your child will have an opportunity to take educational field trips away from the school under the supervision of school personnel.It is difficult for us to send home permission slips prior to each field trip and receive a 100% return before field trip departure time. The result is often a hasty effort to obtain last minute parent permission by telephone or a disappointed child who has to stay at school when his/her classmates go on the field trip.Field trips are generally limited to one out-of-town and one or two in-town, walking field trips per year. A notice of time, place and method of transportation will be sent home with your child prior to each field trip. Does your child have permission to participate in class field trips?
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Verification: On this date, I verify that the information provided on this form is accurate and current. Submitting false statements or information relating to residency is defined as a Class A misdemeanor and the district may recover from you tuition payment for any pupil who is enrolled based on false information you provide. *
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