Student Registration Form

Section 1: Student/Contact Information

This is to enroll your student into Bemidji Area Schools. Items needed to complete registration include: Birth Certificate; Immunization Records; Proof of Residency; Custody Paperwork (if applicable).
Student Name *

First Name Middle Name Last Name
Grade *
2021-2022 School Year
Tentative Start Date

Month Day Year
If blank will assume ASAP.
Birth Date *

Month Day Year
Gender *
Place of Birth

City State County
Address *

Street Address

Mailing Address (if different than above)

City State / Province

Postal / Zip Code
Parent Name

First Name Middle Name Last Name
Relationship to Student
Parent E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Employer
Second Parent/Guardian Name

First Name Middle Name Last Name
Relationship to Student
Second Parent/Guardian E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Second Parent/GuardianEmployer

This section is for the Parent/Guardian not living at the address listed above. If not applicable, skip to next page.
Second Parent/Guardian Name with different address

First Name Middle Name Last Name
Address

Street Address

Mailing Address (if different than above)

City State / Province

Postal / Zip Code
Relationship to Student
Mobile Number
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com

Section 2: School Information
Last School Attended

Name of School City/State Date Last Attended
Is the parent/guardian ACTIVE in the military? *

Yes No
Has this student ever been expelled? *

Yes No
Has truancy ever been filed on this student? *

Yes No
Does this student have an IEP (Individualized Education Program) or a 504 PLAN? *

Yes No
If yes, please indicate primary disability.

Section 3: Miscellaneous Information
Is bussing required for student? *

Yes No
If you answered YES above, please click on link to sign up for bussing.

BUS REGISTRATION
Emergency contact (someone other than parents already listed)

Name Relationship to Student Phone number
Emergency contact (someone other than parents already listed)

Name Relationship to Student Phone number
Please list all children in household under age 5

Section 4: Documents required/Certification/Signature

Once your registration has been processed, an email will be sent to you with confirmation and information pertaining to your student's school.
Upload Birth Certificate

Cancel of
Upload Proof of Residence - Utility bill/Lease agreement/Mortgage statement

Cancel of
Upload Immunization Records - Required

Cancel of
Upload Guardian/Foster Parent Paperwork (if applicable)

Cancel of
Please fill out the Racial and Demographic Designation Form

1. Fill out the form in the window below.

2. Click on download.

3. Click

4. Upload your Racial and Demographic Form in the area below.
Upload Racial and Demographic Form (Required) *

Cancel of
Signature

Clear
Should be Empty:

This section is for the Parent/Guardian not living at the address listed above. If not applicable, skip to next page.