2022-2023 Registration
Student Information
Student Name
Student Birthday
*
-
Month
-
Day
Year
Students up to 21 years of age may enroll
Student Address
Student Address
Street Address Line 2
City/State
State / Province
Zip
Student Phone Number
Student Work Phone Number
Student Email Address
example@example.com
Adult Student or Parent/Guardian Signature
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Records Request
North Shore will use this information to obtain records from your previous schools
Name of Last School Attended
Last Grade Level Attempted
Please Select
8th
9th
10th
11th
12th
Is the student Hispanic or Latino?
Please Select
Yes
No
Decline to answer
Race
Please Select
Asian
Black
American Indian/Alaska Native
Hawaiian
White
Decline to answer
Main Language Spoken at Home (By Student)
Does the student have an IEP or receive special services?
Please Select
Yes
No
Unsure
Has the student received classroom accommodations under a 504 Plan?
Please Select
Yes
No
Unsure
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Parent and Guardian Information
Parent/Guardian Name
Optional for students 18 and older
Second Parent/Guardian Name (Optional)
Cell Number
Parent Primary Email
example@example.com
Relationship to Student
Please Select
Mother
Father
Stepmother
Stepfather
Foster Mother
Grandmother
Father
Stepfather
Guardian
Other
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Emergency Medical Form
In the event you are unable to contact me at the above numbers, you have my permission to contact the following alternates. They have my permission to receive health care information regarding my child and can take my child home during school hours if needed.
Emergency Contact Name
Relationship
Best Contact Number
Doctor Name
Hospital Name
Today's Date
/
Month
/
Day
Year
Date
Upload Proof of Residency (Not Required to complete registration)
Browse Files
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Choose a file
A photo of a utility bill, lease, mortgage statement, or court document with your current address. If you dont have one of these please submit your application and we can help you find the proper document.
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of
Birth Certificate (Not Required to complete registration)
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Choose a file
If you dont have your birth certificate we can order a copy for you.
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of
Submit
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