Student Enrollment & Release Form: SPROUTS

Student Enrollment & Release Form 2024-25: MELSTONE PUBLIC SCHOOLS

Fill out the form carefully for registration
Student Name 1*

First NameLast Name
Birth Date*

MonthDayYear
Sex*

MaleFemale
Ethnic Category*

AsianCaucasian or WhiteBlack or African AmericanNative Hawaiian or Pacific IslanderHispanic or LatinoAmerican Indian or Alaska Native
Student Name 2

First NameLast Name
Birth Date

MonthDayYear
Sex

MaleFemale
Ethnic Category

AsianCaucasian or WhiteBlack or African AmericanNative Hawaiian or Pacific IslanderHispanic or LatinoAmerican Indian or Alaska Native
Student Name 3

First NameLast Name
Birth Date

MonthDayYear
Sex

MaleFemale
Ethnic Category

AsianCaucasian or WhiteBlack or African AmericanNative Hawaiian or Pacific IslanderHispanic or LatinoAmerican Indian or Alaska Native
Student Name 4

First NameLast Name
Birth Date

MonthDayYear
Sex

MaleFemale
Ethnic Category

AsianCaucasian or WhiteBlack or African AmericanNative Hawaiian or Pacific IslanderHispanic or LatinoAmerican Indian or Alaska Native
Student Name 5

First NameLast Name
Birth Date

MonthDayYear
Sex

MaleFemale
Ethnic Category

AsianCaucasian or WhiteBlack or African AmericanNative Hawaiian or Pacific IslanderHispanic or LatinoAmerican Indian or Alaska Native
Parent 1 or Guardian's Name*

First NameLast Name
Parent 2 or Guardian's Name*

First NameLast Name
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Cell Number Mother
Cell Number Father
Email Parent 1
example@example.com
Email Parent 2
example@example.com
Parent's Name not residing with student

First NameLast Name
Secondary Address Parent(s) not residing with student

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Primary Emergency Contact*

First NameLast Name
Phone Number*
Do you have internet at home?*

YESNO

Date*

MonthDayYear
Date
Signature of Parent or Legal Guardian:*

Clear
Should be Empty:

Student Enrollment & Release Form 2024-25: MELSTONE PUBLIC SCHOOLS

STUDENT HANDBOOK

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