PRETTY WATER PUBLIC SCHOOL

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Enrollment Form - New Students

Please Fill Out The Enrollment Form - New Students Below

Student's First Name

Student's Middle Name

Student's Last Name

Grade

Gender

Birth Date

Student's Information

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Primary Phone Number

Secondary Phone Number

Place of Birth

Is your child of Hispanic/Latino culture or origin

What is your child's race? (Choose one or more)

Black

American Indian

Asian

Pacific Islander

White/Caucasian

Name of Parent/Legal Guardian #1

Relationship to Student Min: 3 Max: 30

Address for Parent/Legal Guardian #1

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Primary Phone Number

Secondary Phone Number

Employer Max: 30

Email

Do you live in the household with the student?

Name of Parent/Legal Guardian #2

Relationship to Student Min: 2 Max: 30

Address for Parent/Legal Guardian #2

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Primary Phone Number

Secondary Phone Number

Employer Max: 30

Email

Do you live in household with student?

Name of Emergency Contact (#1)

Relationship to Student

Primary Phone Number

Secondary Phone Number

Name of Emergency Contact (#2)

Relationship to Student

Primary Phone Number

Secondary Phone Number

Physician's Name Max: 35

Physician's Phone Number

My child may walk home from school?

Name of Last School Student Attended

Address of Last School Student Attended

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Parent/Legal Guardian Signature

Date Signed

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