BIGFORK SCHOOLS STUDENT REGISTRATION INFORMATION
STUDENT’S FULL NAME______M_____ F_____
DATE ENROLLED______TEACHER______GRADE______BUS______
BIRTHDATE______BIRTHPLACE______
PRIMARY LANGUAGE SPOKEN IN HOME______2ND LANGUAGE SPOKEN IN HOME______
RACE (PLEASE CIRCLE ONE)
WHITE/NON-HISPANICAMERICAN INDIAN/AK NATIVEASIAN AMERICAN
HISPANIC/LATINOBLACK/AFRICAN AMERICANNATIVE HAWAIIAN/PACIFIC ISLANDER
ADULT (s) THAT STUDENT LIVES WITH
*NAME______RELATIONSHIP TO STUDENT______
MAILING ADDRESS______
STREET ADDRESS______TELEPHONE______
CITY/STATE______ZIP______COUNTY______
EMPLOYER______WORK PHONE______CELL PHONE______
*NAME______RELATIONSHIP TO STUDENT______
MAILING ADDRESS______
STREET ADDRESS______TELEPHONE______
CITY/STATE______ZIP______COUNTY______
EMPLOYER______WORK PHONE______CELL PHONE______
ADULT THAT DOES NOT LIVE WITH CHILD BUT HAS RIGHTS TO STUDENT’S RECORDS
NAME______RELATIONSHIP TO STUDENT______
MAILING ADDRESS______
CITY/STATE______ZIP______
EMPLOYER______WORK PHONE______CELL PHONE______
Do you give permission for the person listed above to pick up your student? YES_____ NO_____
NAME OF LAST SCHOOL ATTENDED______
HAS YOUR CHILD RECENTLY BEEN EXPELLED OR HAD A LONG-TERM SUSPENSION AT ANY OTHER SCHOOL DISTRICT:
YES_____ NO_____
PLEASE LIST ALL BROTHERS AND/OR SISTERS UNDER THE AGE OF 18:
NAME / AGE / GRADEEMERGENCY CONTACTS
(If parent is not available, I give permission to contact and/or release student to the following):
NAME______PHONE______CELL______
ADDRESS______
NAME______PHONE______CELL______
ADDRESS______
NAME______PHONE______CELL______
ADDRESS______
MEDICAL ALERT
HEALTH PROBLEMS______
ALLERGIES______
MEDICATION (TAKEN REGULARLY)______
PHYSICIAN NAME______PHONE______
I give permission for my son/daughter to participate in walking and/or in-district field trips.
______
Signature of Parent/Guardian
I give permission for my son/daughter to receive emergency medical attention for any and all injuries/medical emergencies which he/she may incur as a result of being involved with any activity sponsored by School District #38. I acknowledge that I assume financial responsibility for all treatment. I realize that should I choose not to give permission for treatment, I assume complete responsibility for any complications which may result from a lack of medical treatment.
______
Signature of Parent/Guardian
Occasionally we have students’ names and pictures printed in school publications, newspapers, yearbooks, etc. Names are also released for awards and recognition to media. We do not publicly release any student enrollment information without permission. Permission is given to allow this release of information.
______
Signature of Parent/Guardian
I understand that I must contact the Elementary/Middle School office as soon as possible if my child will be absent from school. In the event that I am unable to do so, I understand that the Elementary/Middle School office staff will contact me regarding my child’s absence.
______
Signature of Parent/Guardian