School Registration Form

IL Millbrae

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1. Student's Name (Required.)

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2. Gender

Female

Male

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3. Desire start date

Date / Time

Date

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4. School (Required.)

Meadows Elementary

Green Hill Elementary

Spring Valley Elementary

Lomita Park Elementary

Franklin Elementary

Lincoln Elementary

Hoover Elementary

McKinley Elementary

John Muir Elementary

Other (please specify)

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5. Does the student need transportation service? (Required.)

Yes

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6. Does the student have a sibling currently enrolled or previously registered at our school?

Yes

If yes, please write the student's name.

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7. Home Address (Required.)

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8. Student Date of Birth (Required.)

Date

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9. Student Information (Required.)

Year level

Semester

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10. Program Option Days (Please Check) (Required.)

5 Days K-5TH $695 ; TK $750

4 days K-5TH $675 ; TK $725

3 days K-5TH $655 ; TK $700

If you choose the program for four or three days per week, please specify the fixed days, for example, M W TH.

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11. Mother’s Name(or guardian) (Required.)

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12. Mother’s (or guardian) email address (Required.)

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13. Mother’s (or guardian)phone (Required.)

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14. Mother’s(or guardian) work address

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15. Father’s Name(or guardian)

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16. Father's (or guardian) email address

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17. Father’s (or guardian)phone

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18. Father’s (or guardian) work address

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19. Have you previously applied to or attended this school? (Required.)

Yes

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20. Does the student have any special needs or require any accommodations? (Required.)

Yes

If yes, please describe in detail

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21. Does the student have any allergies? (Required.)

Yes

If yes, please list

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22. Does the student have any medical conditions or take any medications? (Required.)

Yes

If yes, please describe:

School Registration Form

IL Millbrae

Question Title

* 1. Student's Name (Required.)

Question Title

* 2. Gender

Question Title

* 3. Desire start date

Question Title

* 4. School (Required.)

Question Title

* 5. Does the student need transportation service? (Required.)

Question Title

* 6. Does the student have a sibling currently enrolled or previously registered at our school?

Question Title

* 7. Home Address (Required.)

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* 8. Student Date of Birth (Required.)

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* 9. Student Information (Required.)

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* 10. Program Option Days (Please Check) (Required.)

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* 11. Mother’s Name(or guardian) (Required.)

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* 12. Mother’s (or guardian) email address (Required.)

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* 13. Mother’s (or guardian)phone (Required.)

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* 14. Mother’s(or guardian) work address

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* 15. Father’s Name(or guardian)

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* 16. Father's (or guardian) email address

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* 17. Father’s (or guardian)phone

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* 18. Father’s (or guardian) work address

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* 19. Have you previously applied to or attended this school? (Required.)

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* 20. Does the student have any special needs or require any accommodations? (Required.)

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* 21. Does the student have any allergies? (Required.)

Question Title

* 22. Does the student have any medical conditions or take any medications? (Required.)

1. Student's Name (Required.)

2. Gender

3. Desire start date

4. School (Required.)

5. Does the student need transportation service? (Required.)

6. Does the student have a sibling currently enrolled or previously registered at our school?

7. Home Address (Required.)

8. Student Date of Birth (Required.)

9. Student Information (Required.)

10. Program Option Days (Please Check) (Required.)

11. Mother’s Name(or guardian) (Required.)

12. Mother’s (or guardian) email address (Required.)

13. Mother’s (or guardian)phone (Required.)

14. Mother’s(or guardian) work address

15. Father’s Name(or guardian)

16. Father's (or guardian) email address

17. Father’s (or guardian)phone

18. Father’s (or guardian) work address

19. Have you previously applied to or attended this school? (Required.)

20. Does the student have any special needs or require any accommodations? (Required.)

21. Does the student have any allergies? (Required.)

22. Does the student have any medical conditions or take any medications? (Required.)