AEC 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 NameMiddle NameLast Name
Grade*
2021-2022 School Year
Tentative Start Date

MonthDayYear
If blank will assume ASAP.
Birth Date*

MonthDayYear
Gender*
Place of Birth

CityStateCounty
Address*

Street Address

Mailing Address (if different than above)

CityState / Province

Postal / Zip Code
Parent Name

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

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

Section 2: School Information
Last School Attended

Name of SchoolCity/StateDate Last Attended
Is the parent/guardian ACTIVE in the military?*

YesNo
Has this student ever been expelled?*

YesNo
Has truancy ever been filed on this student?*

YesNo
Does this student have an IEP (Individualized Education Program) or a 504 PLAN?*

YesNo
If yes, please indicate primary disability.

Section 2: School Information