Back to School Registration Form Question Title * 1. Student's First Name Question Title * 2. Student's Last Name Question Title * 3. Fall 2015 Grade Level 6th 7th 8th 9th 10th 11th 12th PG Question Title * 4. Status Day Student Boarding Student Question Title * 5. Which race/ethnicity best describes the student? American Indian or Alaskan Native Asian / Pacific Islander Black or African American Hispanic American White / Caucasian Multiple ethnicity / Other (please specify) Question Title * 6. What is the primary language spoken at home? (Please choose only one.) English Chinese French German Italian Korean Russian Spanish Tagalog Vietnamese Other/multiple languages (please specify) Question Title * 7. I give my child permission to attend overnight School trips accompanied by a Hun School faculty or staff member. Yes No Question Title * 8. Does this child have health insurance, including NJ FamilyCare/Medicaid, Medicare, private, or other? Yes No, My child does not have health insurance. You may release my name and address ot the NJ FamilyCare Program to contact me about health insurance. NJ FamilyCare provides free or low cost health insurance for uninsured children and certain low income parents. Next
