Elementary Student Registration

Student Information

Choose *

Answer Required

New Student

Returning Student

Todays Date*

Answer Required

Students Legal First Name*

Answer Required

Students Legal Middle Name

Answer Required

Students Legal Last Name*

Answer Required

Student ID

Answer Required

Preferred Name

Answer Required

Grade Entering*

Answer Required

Date of Birth*

Answer Required

First language spoken by student*

Answer Required

Languages spoken at home*

Answer Required

Do you need interpreter?

Answer Required

YES

Is the student living with their parents or legal guardian in someone else's house other than your own, living with a friend or family member other than their parent/guardian; living at a shelter, at a hotel or motel, or in a vehicle or campground (unsheltered)? *

Answer Required

YES

Is there a court order that restricts either parent from contact with your student or access to student records? *

Answer Required

YES

Emergency Contact When Parents/Guardian Cannot Be Reached: (Do not include person listed as Parent/Guardians.) I authorize the district to release any and all identifiable information about my student to the following persons. Initial to authorize this person to pick up or sign your student out on your behalf. No student will be allowed to sign out without proper phone call or note from parent.

Name\Phone number\Relationship to child

Answer Required

Special Services: Does your student have an IEP for special Education or a 504 accommodation plan?

Answer Required

IEP

504

List brothers, sisters, stepbrothers, and stepsisters younger than 20 years of age who currently reside within the Soap Lake District. Do not include your student for whom this form is completed.

First/Last Name

Answer Required

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Email 1

Answer Required

Email 2

Answer Required

Mobile Phone

Number Required

Home Phone

Number Required

Work Phone

Number Required

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Home Phone*

Number Required

Parent/Guardian 1 Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email*

Answer Required

Mobile Phone*

Number Required

Work Phone

Number Required

Parent/Guardian 2 Information

First Name

Answer Required

Middle Name

Answer Required

Last Name

Answer Required

Question

Answer Required

Mobile Phone

Number Required

Work Phone

Number Required

Emergency Contact Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Relationship to Student*

Answer Required

Email*

Answer Required

Phone*

Number Required

Family Doctor Information

Name

Answer Required

Phone

Number Required

The following information may be released without obtaining parental consent: student's name, parent's name, grade level, participation in school-based activities and sports, dates of enrollment, honors and awards received, artwork or course work displayed by the district, and photographs, videos, digital images, and recorded sound that have been prepared for public Initials consumption and would not be considered harmful or an invasion of privacy. If you don't want the district to release the information listed above, you must submit a written notice to your school within 10 days of completing this form.

INITIALS

Answer Required

I verify that the information provided on this form is accurate and current. *

Signature Required

This is the inital form for enollment. Additional documents are required. Please call the Elementary Secretary at 509-246-1323 for more information on how to enroll your student. Thank you

Please fix the highlighted areas below before submitting.

Elementary Student Registration