• Pangburn High School 

    Pangburn High School 

    1100 Short Street, Pangburn, Ar 72121 www.pangburnschools.org (501) 728-3513

  • 2026-2027 NEW STUDENT REGISTRATION FORM

    This form is for first-time students enrolling in grades 7th through 12th at Pangburn High School.

  • Student Information

  • Format: (000) 000-0000.
  • Student's Birthday *
     - -

  • Extra Curricular

  • Clubs for 2026sy
  • Sports for 2026sy

  • TRAVEL INFORMATION

  • Travel To School*
  • Travel From School*

  • Guardian/Parent Information

  • Guardian / Mother Information

  • Format: (000) 000-0000.

  • Guardian / Father's Information

  • Format: (000) 000-0000.

  • Emergency Contact Information

  • Format: (000) 000-0000.

  • Sibling Information

  • Birthday
     - -
  • Birthday
     - -
  • Birthday
     - -

  • Check out list/ Pick up list

    Please list any individuals, other than guardians, who are authorized to pick up your student. Only the individuals listed below will be permitted to pick up the student from school (limit of three). All authorized individuals must present proper identification upon request.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Consent forms from handbook

    Digital copy of the handbook can be found on the school website under the red student handbook tab. https://www.pangburnschools.org/
  • Chemical Screening Consent Form (Handbook pages 129-132)*
  • Student Electronic Device And Internet Use Agreement Form (Handbook pages 52-55)*
  • Chromebook Use and Procedure Policy (Handbook pages 133-139)*
  • Publication of Directory Information - Allow Military recruiters', institutions of postsecondary education, and potential employer's (Handbook pages 32)*
  • Permission to display student photo on school website, Facebook, newspaper, and/or yearbook (Handbook pages 32)*
  • Home/School Learning Compact (Handbook pages 147)*
  • Attendance Policy- Students are not allowed to have more than 8 absences per semester. Parent and Guardian notes are NOT accepted. (Handbook page 23-27)*

  • Corporal Punishment

    School Board policy and the laws of the State of Arkansas allow the use of corporal punishment as an option in the discipline plan.  This form is provided to give you, the parent/guardian, the option of whether or not you will allow an administrator or certified staff member of Pangburn Public Schools to use corporal punishment as a discipline option for your child.  A written notice will be sent home if your child receives corporal punishment.
  • Please check one of the options below to ALLOW or NOT ALLOW your child to receive corporal punishment by an administrator or certified teacher if such an action should become necessary.*
  • Format: (000) 000-0000.

  • DIGITAL EQUITY SURVEY

  • Does this child have Internet Access at home?*
  • If there is no Internet Access, what is the reason this child does NOT have internet Access?*
  • What type of Internet Access does this child have? (Select one of the following)*
  • Is the Internet Performance acceptable for learning activities?  (Select one of the following)*
  • What type of device does this child use most often to complete learning activities away from school?  (Select one of the following)*
  • What is the source of this primary learning device?*
  • What is the child's access to this primary learning device?  (Select one of the following)*

  • Student Residency Questionnaire

  • Birthday*
     - -
  • Person completing form:*
  • Format: (000) 000-0000.

  • Please answer these questions about the student’s residency. The information you provide is confidential and protected by the law called the Federal Education Rights and Privacy Act. We use this information to decide which schools students should attend. We also use this information to make sure the rights of a child, youth or an unaccompanied youth are met based on alaw called the McKinney-Vento Homeless Assistance Act.

  • Is the student’s address a temporary living arrangement?*
  • Is the student’s living arrangement due to loss of housing or financial hardship?*

  • If the answer to any of the above is YES, please complete the following:

  • Where is the student identified above currently living?

  • Registration Information.

    Birth Certificate, Social Security Card, Shot Record, Proof of Residency {utility bills (electric, water, cable, etc.) with point of service address and your name must be visible} This cannot be a shut off notice. Any Medical Documentation (If applicable) Documentation of Custody Agreements (If Applicable) Please bring a copy of each to the school office.
  • Primary Race
  • ADDITIONAL RACES (check all that apply):

  • Past School Information

  • Format: (000) 000-0000.
  • Does your student attend/participate or qualify for any of the following programs (check all that apply)

  • Health History Form

    2026-2027 School Year
  • Student's Date of Birth*
     - -

  • Giving Medication

    The following NON-PRESCRIPTION medications, Acetaminophen (Tylenol), Ibuprofen (Advil), Tums, & topicals (triple antibiotic,hydrocortisone, etc). I understand that the school nurse (or trained staff) will determine if the medication is needed, and will administer the age/weight appropriate dose. Generic forms of the medications may be used. I understand that unexpected adverse reactions may occur from any medication, and hereby release the Pangburn School District and its employees from any liability related to such unexpected reactions.

    *As a general rule these medications are not given before 10:00 a.m. or after 2:00 p.m. to reduce the possibility of over- medicating any student. All over-the-counter (OTC) non-prescription medications are available to students on a limited basis. Students who require frequent doses of these OTC meds must bring their own supply, and a parent must come in to discuss the use of OTC medications. Benadryl is given ONLY in cases of acute allergic reactions – no other OTC allergy medications are provided by the school.

  • Can medication be given to your student?*

  • In the event of a medical emergency and an ambulance is called, EMS will determine the appropriate care

  • What type of insurance does your student have?

  • With parental consent, the school district can seek federal Medicaid reimbursement for the cost of the health services the school district provides to children who are eligible for Medicaid.  In order to seek the federal Medicaid funds for reimbursement, the school district must disclose information from your child’s education records to Medicaid and Medicaid billing agencies.

    In compliance with the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) In compliance with the Family Education Right to Privacy Act (FERPA) (20 USC § 1232G; 34 CFR Part 99).I give permission for any child to participate in the School Immunization Clinic. I understand that the appropriate Arkansas Department of Health consent forms will be provided for my consideration prior to the clinic. 


    I will notify the school of any change in address, phone number, emergency contact, or child’s health status. I understand that the information on this form may be released to appropriate School District employees and emergency personnel in order to facilitate health care for my child

  • Rows
  • Does your student have any allergies or a history of allergic reactions?*
  • Does your student take any medication*
  • Should be Empty: