2021-2022 NSHS Registration

2021-2022 Student Registration
Student's Name *

First Name Last Name
Student's Birthday *

Month Day Year
Date
Student Age *
We can enroll students ages 14-21
Student Cell Phone *
Student Email *
example@example.com
Student's Address

Student Address

Apartment Number

City State

Zip Code
Name of Last School Attended: *
Name of the last school you attended
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

Race: Asian, Black, American Indian/Alaska Native, Hawaiian or White
Is the student Hispanic or Latino?

Yes No
Parent/Guardian Signature or Signature of Student 18 years or older: *

This signature lets us know that the provided information so far on the application is correct Clear
Special Education Services

These questions let us know if at your previous school you received special accommodations for your learning
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
Parent/Guardian #1 Information

One parent/guardian information is required for students under 18 years old
Parent/Guardian #1 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 State

Zip Code
Date:

Month Day Year
Today's Date
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 Name:
First and Last Name - Different name from Parent/Guardian #1
Parent/Guardian #2 Cell Phone Number
Parent/Guardian #2 Primary Email:
example@example.com
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 State

Zip Code
North Shore High School Emergency Medical Form

In case of an emergency, please provide contacts we can reach out to to inform them of what is going on. IF YOU HAVE LISTED PARENTS/GUARDIANS EARLIER IN THE APPLICATION, PLEASE CHOOSE DIFFERENT CONTACTS FOR US TO CONTACT.
Emergency Contact #1 Name
First and Last Name - Cannot be a name already listed on application
Relationship:
Best Contact Phone Number:
Emergency Contact #2 Name (other than Parent/Guardian)
Relationship:
Best Contact Phone Number:
Treatment for Emergency Situations

Please provide either a doctor's name or a hospital where you would like to be transported if something where to happen to you at the school building.
In the event of an emergency, I give consent for North Shore High School to contact the doctor or hospital provided below if I am unresponsive (passed out).

Yes No
Student's Doctor Name
If you answered YES above, doctor's name/phone number or hospital name is needed.
Student's Doctor Phone Number
Preferred Hospital Name in a Medical Emergency
The closest hospital to N.S. High School is Marymount Hospital (Cleveland Clinic). Change the name if you would like to be transported elsewhere.
City of Hospital
If you answered NO above, please provide instructions on what we should do during an emergency if you are unresponsive:
This information will be used to make sure you receive treatment when you are unable to communicate
Consent for North Shore High School to Request Previous School Records

By signing, you are allowing for North Shore High School to request your student records from the last school you attended.
Parent/Guardian/Adult Student Signature for Release of Records: *

Clear
Submit Application / Attach Documents Needed for Enrollment

You do not need these documents right now if you do not have access to them. Hit submit to send in your application. We will need them to complete enrollment
Proof of Residency

Upload Parent/Guardian Proof of Residency Document - Some examples include Lease, Electric, Water, Gas Bill, Bank Statement or other Official Document with parents/guardian address (including students 18-22). If the bills are in the student's name, we will also need a proof of income (paystub in student's name)
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
Copy of Student's Birth Certificate

If you don't have this we can help you get a copy from your last school. Just submit the application without it.
Upload a Copy or Photo of Student's Birth Certificate Here

Click to Upload Document

Cancel of
Should be Empty:

2021-2022 Student Registration

Special Education Services

Parent/Guardian #1 Information

Parent/Guardian #2 Information

North Shore High School Emergency Medical Form

Treatment for Emergency Situations

Consent for North Shore High School to Request Previous School Records

Submit Application / Attach Documents Needed for Enrollment

Proof of Residency

Copy of Student's Birth Certificate