1. Please answer the questions as accurately as possible.

The collected information will be used for student registration and for communication to the parent.

1. Parent's First Name

2. Parent's Last Name

3. Child's First Name

4. Child's Last Name

5. Child's gender

6. Child's Street Address

7. Child's City

8. Child's Zip Code

9. Parent Phone Number (Home)
(Please include the area code using this format: ###-###-####)

10. Alternate Parent Phone Number (cell or work)
(Please include the area code using this format: ###-###-####)

11. Emergency Contact Name and Phone Number

12. Parent/Guardian Email Address

13. Parent/Guardian Email Address
(optional additional email address)

14. Child's Current Grade Level
(2016-2017 school year)

15. School attending now

16. Does your child require Special Education services?

17. Does your child have health or medical concerns.

18. Do you need latchkey services for your child?
(hourly rates apply)

19. Do you need transportation services for your child?
(transportation is available for in-district students who live more than one mile from Steenland Elementary)

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