2017-2018 Student Enrollment Packet - New Student
Email address *
Student Information Card
Every student MUST have a completed Student Information Card on file for each school year.
Student First Name: *
Your answer
Student Last Name: *
Your answer
Student Middle Name:
Your answer
Student Preferred Name: *
Your answer
2017-2018 Student Grade: *
Student Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian #1 Name: *
Your answer
Parent/Guardian #2 Name:
Your answer
Parent/Guardian #1 Home Phone: *
Your answer
Parent/Guardian #2 Home Phone:
Your answer
Parent/Guardian #1 Cell Phone:
Your answer
Parent/Guardian #2 Cell Phone:
Your answer
Parent/Guardian #1 Email:
Your answer
Parent/Guardian #2 Email:
Your answer
Physical Street Address of Home (include City & Zip): *
Your answer
Mailing Address (if different from residence - include City & Zip):
Your answer
Parent/Guardian #1 Employer - please include company name, address and phone number
Your answer
Parent/Guardian #2 Employer - please include company name, address and phone number
Your answer
Student Social Security Number: *
Your answer
Student Gender: *
Student's Race: *
Automated Communication System
BA-CFA utilizes an automated communication system. Please list up to 2 email addresses and up to 2 phone numbers to be used by this service.
Email #1:
Your answer
Email #2:
Your answer
Phone #1:
Your answer
Would you like text messages to be sent to Phone #1?
Phone #2:
Your answer
Would you like text messages to be sent to Phone #2?
Student's Insurance Information
Please list any and all SERIOUS HEALTH ISSUES that BA-CFA should be aware of below.
Your answer
Policy Holder's Name:
Your answer
Employer:
Your answer
Insurance Company:
Your answer
Policy Number:
Your answer
In the event of an emergency where you cannot be reached do you authorize treatment of your child by a physician? *
Emergency Information
In the event of an extreme emergency, and none of the individuals listed on the Student Information Card, can be contacted, school authorities will call the nearest medical service or send the student to the nearest hospital.

Please instruct your child where you want him/her to go in case of an emergency school closing during the school day due to fire, power failure, water main break, storm, etc. Your child should know whether to go home to a relative or neighbor or follow instructions that you have given. Thank you for your cooperation.

Emergency School Closing Procedure for Student
In case of emergency school closing during the day, my child is going to:
Emergency Contact #1 - Name: *
Your answer
Emergency Contact #1 - Relationship: *
Your answer
Emergency Contact #1 - Address: *
Your answer
Emergency Contact #1 - Phone: *
Your answer
Emergency Contact #1 Cell Phone:
Your answer
Emergency Contact #1 Email Address:
Your answer
Emergency Contact #2 Name:
Your answer
Emergency Contact #2 Relationship:
Your answer
Emergency Contact #2 Address:
Your answer
Emergency Contact #2 Phone:
Your answer
Emergency Contact #2 Cell Phone:
Your answer
Emergency Contact #2 Email Address:
Your answer
Home Language Survey
What is the first language you learned to speak? *
Your answer
What language do you speak most often? *
Your answer
What language is most often spoken in your home? *
Your answer
Besides languages studied in school, do you speak any language(s) other than English? *
If yes, what language?
Your answer
Media Release Consent: *
Field Trip Permission
This general field trip to applies to all field trips. An additional field trip permission form may be required for out of town trips. All transportation for field trips, whether bus, van or car, will be provided with maximum safety of each child in mind. Parents will be informed in advance of upcoming field trips, any costs and times of departure and return.
My child has permission to participate in field trips. *
Does your student have an immediate family member that has been in the military since September 1, 2001? *
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