New Student Registration Form

FAMILY AND EMERGENCY CONTACT INFORMATION
Parent/Guardian 1 will be the primary address and phone number for the student.
Parent/Guardian Full Name*
Relationship*
Preferred Language*
Primary Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip
Click all that apply for this parent/guardian:*

Lives with the studentHas legal/joint custody of the studentCan be called in case of an emergencyCan pick up the student
Siblings attending Goshen Comm Schools
Parent/Guardian 2- If address is the same as Parent/Guardian 1, state SAME AS ABOVE
Full Name
Relationship
Preferred Language
Primary Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip
Click all that apply for this parent/guardian:

Lives with the studentHas legal/joint custody of the studentCan be called in case of an emergencyCan pick up the student
Siblings attending Goshen Comm Schools

PLEASE ADD AT LEAST ONE ADDITIONAL EMERGENCY CONTACT. *By adding an individual below you are giving permission to your student's school to call and pick up the student if primary contacts are not available.*

	Full Name	Address, City, State, Zip	Phone Number	Relationship to Student	Preferred Language
1
2
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4

Student Handbook Acknowledgement Form

The student handbook is presented to assist you in your understanding of the general operation of the school. Goshen Community Schools consists of one high school, one junior high school, one intermediate and six elementary schools. Each operates under the rules, regulations, and policies as established by the State of Indiana, the Board of School Trustees, and directives from the Office of the Superintendent. Each school, however, may have some variations in general administrative procedures to provide for differences that exist in various parts of the district. Your acknowledgement and understanding of school policies is important in helping your child make a satisfactory adjustment to the school community. For public information about school policy, go to https://go.boarddocs.com/in/goshen/Board.nsf/Public The student handbook can be located by visiting www.goshenschools.org/school-handbooks Please take the time to visit the handbook for rules, guidelines, procedures, and policies of the school corporation. It is all pertinent information, but please pay close attention to:

Technology Agreement Cell phone usage

Please sign below to acknowledge that you were provided the link to the student handbook and an overview of the importance of reviewing its contents to help your student make a satisfactory adjustment to the school community.
Student Name*
School
Grade
Parent Printed Name*
Parent Signature*

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Student Legal Name*
Goshen Community Schools policies are designed to keep custodial conflicts out of the school setting. Our policies seek to ensure the safety of all our students. Goshen Community Schools needs a copy of all court documents related to custody, paternal rights, paternity, etc.

Because of Indiana Law, IC 31-14-7-1 related to legal custody, we need you to answer the following questions:
Were you married at the time of your student's birth?*

YesNo
If no, are there any court papers in place related to physical custody, legal custody, paternity, etc.?

YesNo
Have you brought these custody documents to registration today?

YesNo

I __________parent/guardian of ____________ DOB___________ Goshen Community Schools permission to release the following information to the Indiana State Department of Health's Children and Hoosiers Immunization Registry Program (CHIRP): All immunization records and personal identifying information from the CHIRP data base. For example, but not limited to: name, address, phone number, birth date, school name.
I understand that the information in the registry may be used to verify that my child has received proper immunizations and to inform me or my child of my child's immunization status or that an immunization is due according to recommended immunization schedules.
I understand that my child's information may be available to the immunization data registry of another state, a healthcare provider or a provider's designee, a local health department, an elementary or secondary school, a childcare center, the office of Medicaid policy and planning or a contractor of the office of Medicaid policy and planning, a licensed child placing agency, and a college or university. I also understand that other entities may be added to this list through amendment to I.C. 16-38-5-3. I hereby consent to the release of such information.
Student Full Name Parents Full Name Student Date of Birth
Signature*

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Date

MonthDayYear
Date
Printed name of parent or guardian
Student's Name

	YES	NO
Heart Problem / defect
ADD / ADHD
Anemia ( Includes sickle cell )
Arthritis
Hepatitis
Blood / Clotting Disorder
Cancer / Leukemia
Diet Restrictions
Head Injury / Concussion
Frequent Headaches
Scoliosis
Premature birth/birth defects
Frequent Colds
Hearing Loss ( Explain in space below)
Frequent Ear Infections
Surgery ( Identify type & year in space below)
Activity Restrictions
Physical Disability
Stomach Problems
Psychological Problems (depression, OCD, etc)
Eye Problem ( Explain below )
Glasses?
Urinary/Kidney Problems
Muscular/Bone Problems

New Student Registration Form

STUDENT INFORMATION

Student Birth Place

Demographics

Primary Address

Former School Info

Special Education

If yes, please ensure attached ECSEC Transfer Form is completed

Special Programs

Home Language Survey

Please answer the following questions regarding the language spoken by the student: Circle One

FAMILY AND EMERGENCY CONTACT INFORMATION

WORK SURVEY

GOSHEN COMMUNITY SCHOOLS RESIDENCY INFORMATION FORM

STUDENT HEALTH HISTORY FORM

ECSEC Transfer Form

ONLY COMPLETE IF STUDENT HAS SPECIAL NEEDS, AN IEP, OR SPEECH

	Child's Name	Date of Birth
1
2
3
4
5

	Students Full Name	Age	Grade	Date of Birth	School
1
2
3