Klamath Home Learning Academy Preliminary Registration for Grades K-8

Please complete this preliminary registration form in its entirety. If your child is already enrolled in the Klamath Falls City Schools district, please indicate. The KHLA registrar will contact you soon to finalize your child's enrollment.

If you have questions please contact Christine Redford at 541-883-4700 ext. 7135 or Ariana Guerrero at 541-883-4700 ext. 7145

How many legal parents/guardians does your student live with?

Parent/Guardian Name

First NameLast Name

Parent/Guardian Phone

Area CodePhone Number

Parent/Guardian Email Address

example@example.com

Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are the Physical Address and Mailing Address the Same?

Parent/Guardian Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

2nd Household Legal Parent/Guardian Name

First NameLast Name

2nd Household Legal Parent/Guardian Phone

Area CodePhone Number

2nd Household Legal Parent/Guardian Email Address

example@example.com

How many students are you registering?

Student Legal Name

First NameMiddle NameLast Name

Student Birthdate

Date

Student Gender

Your student is of what race? Select all that apply.

Grade (Fall 2021)

Does student have a

K-2 grade students are only allowed to select the teacher-led option

3-6 grade students are allowed to select either the teacher-led option or the self-directed/self-paced online option, please choose one.

7-8 grade students are allowed to select only the self-directed/self-paced online option

Was your student enrolled in the Klamath Falls City Schools district during the 2020-2021 school year? (Conger Elementary; Mills Elementary; Pelican Elementary; Roosevelt Elementary; Ponderosa Middle School)

Which school was your student enrolled in during the 2020-2021 school year?

Name of school student attended during the 2020-2021 school year

Phone number of school student attended last year

Area CodePhone Number

Fax number of school student attended last year

Area CodePhone Number

Student Legal Name

First NameMiddle NameLast Name

Student Birthdate

Date

Student Gender

Your student is of what race? Select all that apply.

Grade (Fall 2021)

Does student have a

K-2 grade students are only allowed to select the teacher-directed option

3-6 grade students are allowed to select either the teacher-directed option or the self-directed/self-paced online option, please choose one.

7-8 grade students are allowed to select only the self-directed/self-paced online option

Was your student enrolled in the Klamath Falls City Schools district during the 2020-2021 school year? (Conger Elementary; Mills Elementary; Pelican Elementary; Roosevelt Elementary; Ponderosa Middle School)

Which school was your student enrolled in during the 2020-2021 school year?

Name of school student attended during the 2020-2021 school year

Phone number of school student attended last year

Area CodePhone Number

Fax number of school student attended last year

Area CodePhone Number

Student Legal Name

First NameMiddle NameLast Name

Student Birthdate

Date

Student Gender

Your student is of what race? Select all that apply.

Grade (Fall 2021)

Does student have a

K-2 grade students are only allowed to select the teacher-directed option

3-6 grade students are allowed to select either the teacher-directed option or the self-directed/self-paced online option, please choose one.

7-8 grade students are allowed to select only the self-directed/self-paced online option

Was your student enrolled in the Klamath Falls City Schools district during the 2020-2021 school year? (Conger Elementary; Mills Elementary; Pelican Elementary; Roosevelt Elementary; Ponderosa Middle School)

Which school was your student enrolled in during the 2020-2021 school year?

Name of school student attended during the 2020-2021 school year

Phone number of school student attended last year

Area CodePhone Number

Fax number of school student attended last year

Area CodePhone Number

Student Legal Name

First NameMiddle NameLast Name

Student Birthdate

Date

Student Gender

Your student is of what race? Select all that apply.

Grade (Fall 2021)

Does student have a

K-2 grade students are only allowed to select the teacher-directed option

3-6 grade students are allowed to select either the teacher-directed option or the self-directed/self-paced online option, please choose one.

7-8 grade students are allowed to select only the self-directed/self-paced online option

Was your student enrolled in the Klamath Falls City Schools district during the 2020-2021 school year? (Conger Elementary; Mills Elementary; Pelican Elementary; Roosevelt Elementary; Ponderosa Middle School)

Which school was your student enrolled in during the 2020-2021 school year?

Name of school student attended during the 2020-2021 school year

Phone number of school student attended last year

Area CodePhone Number

Fax number of school student attended last year

Area CodePhone Number

Student Legal Name

First NameMiddle NameLast Name

Student Birthdate

Date

Student Gender

Your student is of what race? Select all that apply.

Grade (Fall 2021)

Does student have a

Was your student enrolled in the Klamath Falls City Schools district during the 2020-2021 school year? (Conger Elementary; Mills Elementary; Pelican Elementary; Roosevelt Elementary; Ponderosa Middle School)

K-2 grade students are only allowed to select the teacher-directed option

3-6 grade students are allowed to select either the teacher-directed option or the self-directed/self-paced online option, please choose one.

7-8 students are only allowed to select the self-directed/self-paced online option.

Which school was your student enrolled in during the 2020-2021 school year?

Name of school student attended during the 2020-2021 school year

Phone number of school student attended last year

Area CodePhone Number

Fax number of school student attended last year

Area CodePhone Number

Student Legal Name

First NameMiddle NameLast Name

Student Birthdate

Date

Student Gender

Your student is of what race? Select all that apply.

Grade (Fall 2021)

Does student have a

K-2 grade students are only allowed to select the teacher-directed option

3-6 grade students are allowed to select either the teacher-directed option or the self-directed/self-paced online option, please choose one.

7-8 students are only allowed to select the self-directed/self-paced online option.

Was your student enrolled in the Klamath Falls City Schools district during the 2020-2021 school year? (Conger Elementary; Mills Elementary; Pelican Elementary; Roosevelt Elementary; Ponderosa Middle School)

Which school was your student enrolled in during the 2020-2021 school year?

Name of school student attended during the 2020-2021 school year

Phone number of school student attended last year

Area CodePhone Number

Fax number of school student attended last year

Area CodePhone Number

NOTE: This Preliminary Registration form is automatically sent to the registrar of KHLA to inform them of your interest in enrolling your student. Once the initial information from this form has been entered into our system you will receive a phone call from our offices at (541) 883-4744. During that conversation, you will be provided with additional information about KHLA, answers to any questions you might have and be provided instruction on how to complete the additional required forms using our Tyler SIS system. Please call the number above if you have not heard from the KHLA office within 3 days.

Students are NOT officially enrolled until such time as you have engaged in the phone conversation with our office and submitted all the required forms.

Thank you for your interest in enrolling your child in the Klamath Home Learning Academy where students and families receive the best home learning options!