Santa Rosa High School Enrollment Form
Student Information
Please Input your Students information below. Ingrese la información de sus estudiantes a continuación.
Name
*
First Name
Middle Name
Last Name
Social Security #
*
Date Enrolled
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Place of Birth
Student Lives with Both Parents?
Please Select
Yes
Mother
Father
Grandparent
Other
Email
*
example@gmail.com
Mobile Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Application Details
Application Type
*
Grade 9
Grade 10
Grade 11
Grade 12
Other
Will your student ride the bus?
Yes
No
N/A
If Yes, Bus # and Bus Driver Name
Admission Application for:
1st Semester
2nd Semester
Student No.
Enrollment Status
Please Select
Old Student
New Student
Educational Background
Middle School
Name of School
*
School Address
*
Street
Street Address Line 2
City
State / Province
Postal / Zip Code
Year Graduated
*
Elementary School
Name of School
*
School Address
*
Street
Street Address Line 2
City
State / Province
Postal / Zip Code
Year Graduated
*
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Student Health
Please List any Allergies the student may have:
Please List any Health concerns the student may have:
Please List any Medications that the student may need to have and/or we need to have for them:
Please List any other unusual health situations your student has:
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Emergency Medical Authorization Form
This link will provide a copy of the EMA form. Please print and fill out this form to be returned to the school upon completion. Este enlace proporcionará una copia del formulario EMA. Imprima y complete este formulario para devolverlo a la escuela al finalizar.
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Home Language and Culture
Our school needs to know the language(s) spoken and heard at home by each child. This information is needed in order for us to provide the best instructional work possible for all students.
1. Is Spanish spoken at Home? ¿Se habla español en casa?
Yes
No
Si
No
1. Is English spoken at Home? ¿Se habla inglés en casa?
Yes
No
Si
No
In the home environment, is your child exposed to cultures, traditions, values, ect... of your ethnic heritage? En el entorno familiar, ¿está su hijo expuesto a culturas, tradiciones, valores, etc. de su herencia étnica?
Yes
No
Si
No
Which language did your child first learn to speak? ¿Qué idioma aprendió su hijo a hablar por primera vez?
What language does your child use the most often at home? ¿Qué idioma usa su hijo con más frecuencia en casa?
What language do you most often use to speak to your child? ¿Qué idioma utiliza con más frecuencia para hablar con su hijo?
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Contact In case of Emergency
Name
First Name
Middle Name
Last Name
Mobile Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship
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Parental Information
Name of Mother
First Name
Middle Name
Last Name
Mother's Job/Position
Mobile Number
Address of Mother
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Father
First Name
Middle Name
Last Name
Father's Job/Position
Mobile Number
Address of Father (if not the same as above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Full Name of Applicant
First Name
Last Name
Applicant's Signature
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I verify all information is correct to the best of my ability.
*
Yes
Submit
Submit
Should be Empty: