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ALL items listed below must be completed and turned in together with your registration packet and fee paid, in order for your child to enter the classroom on the first day of school.
2025-2026 New Student Registration
First
Middle
Last
Grade Entering
Street Address
City
State
Zip
Race/Ethic Group
Gender
Citizenship
Place of Birth
Date of Birth
Phone
Baptized Seventh-day Adventist?
Yes
No
Primary language spoken at home
Social Security Number
Mother/Legal Guardian First
Mother/Legal Guardian Last
Mother/Legal Guardian Middle
Preferred Name
Race
Citizenship
Street Address
City
State
Zip
Place of Birth
Date of Birth
# Years of education Completed
Home Phone
Cell Phone
Relationship to Student
Baptized Seventh-day Adventist?
Yes
No
Membership At?
Work Phone
Email
Marital Status
Occupation
Employer
Employer Phone Number
Father/Legal Guardian First
Father/Legal Guardian Middle
Father/Legal Guardian Last
Preferred Name
Street Address
City
State
Zip
Place of Birth
Date of Birth
# Years of education Completed
Home Phone
Cell Phone
Relationship to Student
Baptized Seventh-day Adventist?
Yes
No
Membership At?
Work Phone
Email
Marital Status
Occupation
Employer
Employer Phone Number
Is English the primary language spoken at home?
Yes
No
If no, what language is the primary language?
Is the family able to communicate in English?
Yes
No
Has the student ever had a psychological/educational assessment?
Yes
No
Has the student ever received execptional/educational services?
Yes
No
If yes, which service Comprhensive Education (small group remediation)
Hearing Disabilities
ESL(English as a Second Language)
Speech Therapy
Gifted
Other
Other:
Has the student ever repeated a grade?
Yes
No
If yes, what grade and explain:
Has the student ever skipped a grade?
Yes
No
If yes, what grade and explain:
Has the student ever been suspended, expelled, asked to withdraw from school, arrested, or on probation?
Yes
No
If yes, please explain:
Has the student experienced any limitations?
Yes
No
If yes, which area and please explain:
Are there legal custody restraint documents?
Yes
No
Custody Type:
Mother
Father
Both Parents
My child will be going home by:
Parents' Car
Carpool
Walk
Daycare Van
Bus Stop
Name
Relationship
Home Phone
Work Phone
Mobile
Name
Relationship
Home Phone
Work Phone
Mobile
Name
Relationship
Home Phone
Work Phone
Mobile
Name
Relationship
Home Phone
Work Phone
Mobile
Name
Relationship
Home Phone
Work Phone
Mobile
Name
Relationship
Home Phone
Work Phone
Mobile
Name
Relationship
Home Phone
Work Phone
Mobile
Name
Relationship
Home Phone
Work Phone
Mobile
Asthma:
Yes (If yes, we have an inhaler in the office for your child)
No
Diabetes:
Yes
No
Allergies:
Yes
No
List Allergies:
Current Medications:
Family Doctor Name:
Street Address
City
State
Zip
Phone
Preferred Hospital:
Insurance Policy No:
Group No:
Policy Holder:
Name of School
Phone
Fax
Street Address
City
State
Zip
Send