Healdton Public Schools 2020-2021 Enrollment Form
Race: (Type an X for all that apply.)
Mark on ethnic identity: (Choose one by typing an X for the appropiate identity.)
Emergency Contacts: (In the event that we are unable to locate the parents/guardian, who can we call?) Name Relationship Home Phone
If yes, who has primary custody? blanks Relationship blank Court documents declaring custody need to be in this child's school file.
If by bus, bus number: blanks
If yes, what is it? blanks
If no, what district? blanks
If no, list school last attended, address and phone number where the student attended. blanks
If yes, please list. blanks
If yes, please explain. blanks
Other Child #1 Name blanks Other Child #1 Grade blank Other Child #2 Name Other Child #2 Grade Other Child #3 Name Other Child #3 Grade Other Child #4 Name Other Child #4 Grade .