Park Rapids Area High School
401 Huntsinger AvenuePark Rapids, MN 56470 / 218-237-6400-phone
218-237-6401-fax /
SAC
/Enrollment Date
Locker # & Combination /Student ID
LLA
/MARSS Number
Student Information
/LEGAL Last Name
/LEGALFirst Name
/LEGAL Middle Name
/Grade
/ Gender Male FemaleStudent Address
/ / Resident District-(School district where student lives)/ Has student ever attended PR Area Schools? Yes No
City
/ State
/ Zip
/ List any previous Minnesota School the student has attended:
Home Phone
/Date of Birth
/ School Student is transferring from – Please listschool name/address/city/state/zip/phone numberLegal Father of Student
/Step-Father of Student
Name Last Name, First Name, Middle Initial
/Name Last Name, First Name, Middle Initial
Address
/Address
City
/State
/Zip
/City
/State
/Zip
Home Phone
/Lives With
/Home Phone
/Lives With
Cell Phone
/Contact Allowed
/Cell Phone
/Contact Allowed
Work Phone
/Education Rights
/Work Phone
/Education Rights
Employer
/Deceased
/Employer
/Deceased
E-mail Address:
/E-mail Address:
Legal Mother of Student
/Step-Mother of Student
Name Last Name, First Name, Middle Initial
/Name Last Name, First Name, Middle Initial
Address
/Address
City
/State
/Zip
/City
/State
/Zip
Home Phone
/Lives With
/Home Phone
/Lives With
/Cell Phone
/Contact Allowed
/Cell Phone
/Contact Allowed
Work Phone
/Education Rights
/Work Phone
/Education Rights
Employer
/Deceased
/Employer
/Deceased
E-mail Address:
/ E-mail Address:Name Last Name, First Name, Middle Initial
Address
City
/State
/Zip
/State
/Zip
Home Phone
/Lives With
/Lives With
Cell Phone
/Contact Allowed
/Contact Allowed
Work Phone
/Education Rights
/Education Rights
Employer
/ Deceased /Deceased
Would you like the school to send correspondence to non-custodial parent? YesNo
Complete this section if student lives with someone other than parentsEmergency Contact #1 – (someone other than parent/guardian)
Name Last Name, First Name, Middle Initial
Address
City
/State
/Zip
Home Phone
/Cell Phone
/Work Phone
/Emergency Contact #2 – (someone other than parent/guardian)
Name Last Name, First Name, Middle Initial
Address
City
/State
/Zip
Home Phone
/Cell Phone
/Work Phone
// Ethnicity Race
American Indian Hispanic/Latino
Asian American Indian or Alaskan
Hispanic Asian
Black Black or African American
White Native Hawaiian or Pacific
White
Home Language
First language learned by student ______Language normally used: By student at home ______
By parents at home ______
By student with friends ______
Migrant Worker
Have you moved to this school district within the last 36 months for temporary or seasonal agricultural or fishing work? Yes No
Student Support Services
Please check the services that this student receives:
Speech/HearingOccupational Therapy/Physical Therapy
Emotional Behavioral Disorder (EBD)
Learning Disabled
EMH/TMH
Title I
None of the above