Kindergarten Enrollment Form - Crown Point Community School

Crow n Point Community School Corporation
Kindergarten Enrollment Form
Student: (Full Name) ______________________________________
Nick Name : ________________________________
Grade: _______
Social Security Number: ____________________
Example: James=Jimmy, Katherine =Katie, William=Will
Male/Female: _______
Date of Birth: ___________________________
Place of Birth: _____________________________
Student's Ethnic Origin Required for State/Federal Civil Rights Reports
Please check all that apply:
_____American Indian/Alaskan Native
_____Black
_____Asian
_____Hispanic/Latino
_____White
_____Native Hawaiian/Pacific Islander
Street Address (No P.O. Box): ____________________________________
City/State/Zip: ______________________________
Mailing Address: _______________________________________________
City/State/Zip: ______________________________
Home Phone: ________________
Unlisted: (Yes/No) ___________
Is this student’s parent(s)/guardians(s) active duty members(s) of the Armed Forces? ___________(Yes/No)
Custodial Information
Student is living with (check one):
Both Parents: ____
Father Only: ____
Mother/Stepfather: ____
Mother Only: ____
Other (please list): ___________________________
Father/Stepmother: ____
Parent/Guardian Name(s): _________________________________
Parent/Guardian E-mail: ______________________
Parent not living with child, but wishes to receive correspondence:
Parent Name(s): _________________________________________
Parent E-mail: ______________________________
Mailing Address: _________________________________________
City/State/Zip: ______________________________
Phone: _______________________
Do you have legal documents concerning special custody instructions? ___________ Yes
__________ No
____________________________________________________________________________________________________________
KINDERGARTEN STUDENTS ONLY:
Has this child had previous:
Kindergarten_____ Nursery School_____ Headstart______ Motessori_____
If so, where?__________________________________ How long?____________________________________________
Is your child currently enrolled in an Early Childhood Development Program? _____
If yes, do they have a current IEP? ______
Please list services received: ______________________________________
Younger children not yet enrolled in school:
Name:
Birthdate:
Name:
Birthdate:
Name:
Birthdate:
Doctor: ______________________________
Emergency Contact Information
Dentist: _______________________________
Phone: ______________________________
Phone: _______________________________
Emergency Contact Call Sequence: This is the order in which you will receive calls from the school nurse or other school official.
School Messenger Call Sequence: This is used for the School Messenger Automated Calling System. Keep in mind that the system
can call up to 5 phone numbers. Sequence 1 will be used for informational phone messages, as well as for emergencies, school
cancellations, or other alerts. Sequences 2 through 5 will NOT receive the informational messages; only the emergency information. If
there are any names below that should not receive these automatic alerts, leave the sequence field blank.
Emergency
Parent/Guardian Home Phone:
Sequence:
Non-custodial Parent Home Phone:
Sequence:
Dad's Employer:
Phone:
Sequence:
Mom's Employer:
Phone:
Sequence:
Dad's Name:
Dad's Cell Phone:
Sequence:
Mom's Name:
Mom's Cell Phone:
Sequence:
Phone:
Sequence:
Phone:
Sequence:
Phone:
Sequence:
Add'l Contact Name:
School
Messenger
Relationship:
Add'l Contact Name:
Relationship:
Add'l Contact Name:
Relationship:
Parent/Guardian Signature:
Date
Printed Name of Parent/Guardian:
FOR OFFICE USE ONLY:
Proof of Residency
_____ Mortgage/Rental Statement
_____ Utility Statement
_____ Transfer Tuition (ASC)
_____ Voluntary Transfer (ASC)
_____ Free/Reduced Meal Application
_____ Social Security Card
_____ Custodial Documentation
_____
_____
_____
_____
_____
_____
Birth Certificate
_____
Immunization Record
_____
Transcript
_____
Home Language Survey
_____
Divorce, Separation (Form 1 ASC)
Third Party Custody (Form 2 ASC)
Date of Enrollment_____________________________________
Standardized Test Scores
Internet Permission
Student Text Number
Affidavit Supporting Residence (ASC)
Enrollment Official_________________________________

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