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School Registration Form 5770 (2009-2010)

by David Diskin — last modified 07-14-2009 09:25 AM
Parent/Guardian #1
(Required)
(Required)
(Required)



(Required)
(Required)
Parent/Guardian #2
if different from parent/guardian #1
if different from parent/guardian #1
if different from parent/guardian #1



if different from parent/guardian #1
if different from parent/guardian #1
Child #1 Basic Info
(Required)
(Required)
use English characters to spell phonetically
(Required)


(Required)
mm-dd-yyyy
indicate parent/guardian that the child lives with.


(Required)
if different from secular grade
Child #1 Health Information
(Required)
Please list general health condition, including any vision, speech, or hearing issues, any specific physical condition or illness - past or present
describe if any and the severity
if any, provide name and purpose of each medication
Child #1 Learning Style Information
If so, please describe them.
i.e. ADD, diagnosed learning difference, IEP, ADHD
i.e. divorce, recent relocation, death in the family, new school new sibling, etc. If yes, please describe.
Please list any additional information that you would like the teachers to know. Please feel free to share hobbies or special interests.
Child #1 Physician Info
(Required)
(Required)
(Required)



Child #1 Friend Request
We would like to place each child with at least one of the three friends listed below.
Child #2 Basic Info
use English characters to spell phonetically


mm-dd-yyyy
indicate parent/guardian that the child lives with.


if different from secular grade
Child #2 Health Information
Please list general health condition, including any vision, speech, or hearing issues, any specific physical condition or illness - past or present
describe if any and the severity
if any, provide name and purpose of each medication
Child #2 Learning Style Information
If so, please describe them.
i.e. ADD, diagnosed learning difference, IEP, ADHD
i.e. divorce, recent relocation, death in the family, new school new sibling, etc. If yes, please describe.
Please list any additional information that you would like the teachers to know. Please feel free to share hobbies or special interests.
Child #2 Physician Info



Child #2 Friend Request
We would like to place each child with at least one of the three friends listed below.
Child #3 Basic Info
use English characters to spell phonetically


mm-dd-yyyy
indicate parent/guardian that the child lives with.


if different from secular grade
Child #3 Health Information
Please list general health condition, including any vision, speech, or hearing issues, any specific physical condition or illness - past or present
describe if any and the severity
if any, provide name and purpose of each medication
Child #3 Learning Style Information
If so, please describe them.
i.e. ADD, diagnosed learning difference, IEP, ADHD
i.e. divorce, recent relocation, death in the family, new school new sibling, etc. If yes, please describe.
Please list any additional information that you would like the teachers to know. Please feel free to share hobbies or special interests.
Child #3 Physician Info



Child #3 Friend Request
We would like to place each child with at least one of the three friends listed below.
Medical Insurance Company
(Required)
(Required)
(Required)
(Required)
Dentist



Emergency Contacts
(Required)
(Required)
(Required)
(Required)
(Required)
(Required)
 
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