STUDENT REGISTRATION

STUDENT REGISTRATION
Entering Grade Level
Date Entering School

MonthDayYear
Date
Has the student been enrolled in the Bowling Green School System before? Please X the appropriate box below.
YES
NO
Student Name :First
Student Name :Last
Student Name :Middle
Street Address
P.O. Box
Apartment/Lot Number
City/State/Zip
Telephone Number
Please X appropriate box below for the child's gender
Sex: Male
Sex: female
Child's Birthdate: Month
Child's Birthdate: Day
Child's Birthdate: Year
Child's Social Security #
Place of Birth: County
Place of Birth: City
Place of Birth: State
Please X appropriate box below School Attended Last Year: Public/Non-Public
Public
Public/Non-Public
Grade Level Last Year
Previous School Name (If Applicable)
Previous School Address (if applicable)

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Please answer the following questions for siblings or other children residing with the student. Thank you!
Other Child in Home #1 NAME:
Please X appropriate box below for the child's gender
Sex: Male
Sex: Female
Other Child in Home #1 AGE:
Other Child in Home #1 NAME OF SCHOOL PRESENTLY ATTENDING:
Other Child in Home #1 GRADE LEVEL:
Other Child in Home #2 NAME:
Please X appropriate box below for the child's gender
Sex: Male
Sex: Female
Other Child in Home #2 AGE:
Other Child in Home #2 NAME OF SCHOOL PRESENTLY ATTENDING:
Other Child in Home #2 GRADE LEVEL:
Other Child in Home #3 NAME:
Please X appropriate box below for the child's gender
Sex: Male
Sex: Female
Other Child in Home #3 AGE:
Other Child in Home #3 NAME OF SCHOOL PRESENTLY ATTENDING:
Other Child in Home #3 GRADE LEVEL:
Student resides with

MotherBoth ParentsRelative, Not GuardianFatherBoth Parents (Shared Custody)Other
Father's Name
Father's Address
Father's Apt/Lot #
Father's PO Box #
Father's Home/ Cell Number
Father's Emergency Number
Father's Place of Employment
Father's Work Number
Does Father reside with the family? Please X appropriate box below.
Yes
No
Mother's Name
Mother's Address
Mother's Apt/ Lot #
Mother's PO Box
Mother's Home/ Cell Number
Mother's Emergency Number
Mother's Place of Employment
Work Telephone
Does Mother reside with the family? Please X appropriate box below.
Yes
No
Please sign below to indicate that the person registering this student is a parent as defined above.
Parent Signature

Clear
Today's Date

MonthDayYear
Date
Should be Empty: