6-8 Registration Form

9-12 Registration Form

Fill out the form carefully for registration
Student Name*

First NameMiddle NameLast Name
Gender*
Grade*
Date of Birth*

MonthDayYear
Birthplace*
Special Education*
Speech*
*If yes to either special education or speech question, stop here and contact the CEC at 810-724-9853. Please attach most current IEP.
Attach current IEP

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Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County of Residence*
Home Phone*

Area CodePhone Number
Student Cell Phone*

Area CodePhone Number
Please list any health considerations, allergies, or medications:*
Ethnicity: is this student (or are you) Hispanic/Latino?*

No, not Hispanic/LatinoYes, Hispanic/Latino
Race*
Is this student tribally affiliated?*

Yes, the student is tribally affiliatedNo, the student is not tribally affiliated
If the student is tribally affiliated, what is their primary tribal affiliation? (Choose only one)
Parent and/or Guardian Information
Father/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status*
Employer Name/Occupation*
Work Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Active Military*

YesNo
Email address*
example@example.com
Mother/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status*
Employer Name/Occupation*
Work Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Active Military*

YesNo
Email address*
example@example.com
Non-Custodial Parent Information

Court documentation must be provided and included in your child's school record if non-custodial parent cannot pick up student from school.
Non-Custodial Parent Name:

First NameLast Name
Who has legal Custody?
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Is student allowed to leave with non-custodial parent?

YesNo
Emergency Contacts (other than parents/guardians)
Family Information
Brothers
Sisters
Other Student Information
Last School Attended:*
Date Left:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Comments and/or additional information:
Presently, is your family living in any of the following situations? Check one box:*

Staying in a shelter, temporary trailer, or waiting for foster care placementDoubled up-sharing the housing with others/relatives due to loss of housing, economic hardship or similar reasonLiving in a motel or hotel due to loss of housing, economic hardship or similar reasonLiving in a motel or hotel due to loss of housing, economic hardship or similar reasonMoving from place to placeLiving with an adult that is not a parent or legal guardianNone of the above
Has your child had chickenpox?*

YesNo
If yes to chickenpox, give month and year.
** I understand that there may be online courses offered to my child and I give my consent for my student to take any course assigned.
Parent/Guardian Signature*
Please sign and date the Registration Form below:
Parent/Guardian Signature*
Date*

MonthDayYear
Date
Should be Empty:

9-12 Registration Form

*If yes to either special education or speech question, stop here and contact the CEC at 810-724-9853. Please attach most current IEP.

Parent and/or Guardian Information

Non-Custodial Parent Information

Emergency Contacts (other than parents/guardians)

Family Information

Other Student Information

** I understand that there may be online courses offered to my child and I give my consent for my student to take any course assigned.

Please sign and date the Registration Form below: