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2021-2022 Student Registration
www.nshighschool.com
Student's Name
*
First Name
Last Name
Student's Birthday
*
/
Month
/
Day
Year
Date
Student's Age
*
We can enroll students up to 21 years old
Student Cell Phone/Parent or Guardian Cell Phone
*
Student's E-mail/Parent or Guardian E-Mail
example@example.com
Student's Address
Student Address
Apartment Number (if needed)
City
State
Zip Code (example 44125)
Parent/Guardian Signature or Signature of Student 18 years or older:
*
Clear
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Consent for North Shore High School to Request Previous School Records
Name of Last School the Student Attended:
Name of the last school you attended to request records
City/State of Last School Attended
If you remember
Last Grade Level Attempted at Previous School
Native Language (First Language Spoken by Child):
CHANGE IF NOT ENGLISH
Main Language Spoken at Home (By Student):
Race: Asian, Black, American Indian/Alaska Native, Hawaiian or White
Is the student Hispanic or Latino?
Yes
No
Parent/Guardian/Adult Student Signature for Release of Records:
Clear
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Special Education Services
These questions let us know if at your previous school you received special accommodations for your learning
Did you/your enrolling student receive any special education accommodations at your last school? (IEP/ETR/504/WEP)
Yes
No
Does/Did the Student have/had an Individual Education Plan (IEP) or receive any special services at school now/in the past?
Yes
No
Does/Did the student have a 504 or receive classroom accommodations now/in the past?
Yes
No
Does/Did the student have a Written Education Plan (WEP)?
Yes
No
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Parent/Guardian #1 Information
One parent/guardian information is required for students under 18 years old
Parent/Guardian #1 First and Last Name:
First and Last Name
Parent/Guardian #1 Cell Phone Number
Parent/Guardian #1 Email:
example@example.com
Relationship to Student
Mother
Stepmother
Foster Mother
Grandmother
Father
Stepfather
Foster Father
Grandfather
Guardian
Is Parent/Guardian #1's address the same as the student?
Yes
No
If you answered NO, please provide your address
Street Address
Apartment/Unit Number
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Parent/Guardian #2 Information
Only one parent/guardian information is required for students under 18 years old. If there is no second Parent/Guardian that would like to receive information, you can skip.
Parent/Guardian #2 First and Last Name:
Parent/Guardian #2 Cell Phone Number
Relationship to Student
Mother
Stepmother
Foster Mother
Grandmother
Father
Stepfather
Foster Father
Grandfather
Guardian
Is Parent/Guardian #2's address the same as the student?
Yes
No
If you answered NO, please provide your address
Street Address
Apartment/Unit Number
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Emergency Contact Information
Emergency Contact #1 First and Last Name
Relationship:
Best Contact Phone Number:
Best Contact Phone Number:
Date
-
Month
-
Day
Year
Date
Enrollment Documents (Optional)
Proof of Residency and Birth Certificate. You do not need these documents right now if you do not have access to them. Hit submit to send in your application with or without them.
Attach Proof of Residency Here
Click to Upload Document
Please take a photo of the entire 1st page of the document that lists the address.
Cancel
of
Upload a Copy or Photo of Student's Birth Certificate Here
Click to Upload Document
Cancel
of
Submit Application
Should be Empty: