Hemlock Creek 5K-4th Grade Pre-Registration (2025-26 School Year)

Student Information
Student's legal name: *

First NameMiddle NameLast Name
Date of birth*

MonthDayYear
Date
Grade:*
For the 2025-26 school year
Gender:*

FemaleMale
Student's primary address (street number):*
Student's primary address (street name):*
If you live in the School District of West De Pere boundaries but don't see your street listed, please email snorred@wdpsd.com or call (920) 337-1393 before completing.
Student's primary address (apartment number, if applicable):
Student's primary address (city):*
Student's primary address (zip/postal):*
Student's primary address*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home phone*
Is this student Hispanic/Latino?*

YesNo
Is this student (choose one or more. You must select at least one):*

WhiteBlack or African AmericanAsianAmerican Indian or Alaskan NativeNative Hawaiian or other Pacific Islander
What is the first language the student learned to speak?:*

EnglishOther
What language does the student speak most often?:*

EnglishOther
Does your child receive Special Ed Services?:*

YesNo
If yes, please explain
Does your child have any medical conditions we need to be aware of?*

YesNo
If yes, please explain
Was your student ever previously enrolled in a school or program in West De Pere?*

YesNo
If yes to a program, what program? (ex: speech, early childhood, etc...) :
If yes to previously attending a school in WDP, what school?:
Student's Birth Certificate Information

Information must match the child's birth certificate or other legal document that must be provided to the school.
Student birth information (must match their birth certificate): *

Street Address

Street Address Line 2

CityState

CountyCountry
Student's Gender (must match their birth certificate):*
If your student was born outside of the US, what is the approximate date the student came to the US?

MonthDayYear
*This information is solely used to apply for additional funding for potential services that may be needed.
Was this a multiple birth?:*

YesNo
Mother or legal guardian's name (from birth certificate or other legal document):*

First NameMiddle NameLast Name
Father or legal guardian's name (from birth certificate or other legal document):*

First NameMiddle NameLast Name
Birth certificate or court order document #:*
*Listed in the upper right corner of the certificate.
Parent/Guardian Information
Parent/Guardian 1 name: *

First NameLast Name
Relationship of parent/guardian 1 to student:*

MotherFatherGuardianOther
Parent/Guardian 1 phone:*
Parent/Guardian 1 address (if different from student):
Parent/Guardian 1 email:*
example@example.com
Parent/Guardian 1 employer: *
Parent/Guardian 1 work phone: *
Parent/Guardian 2 name:

First NameLast Name
Parent/Guardian 2 phone:
Please enter a valid phone number.
Relationship of parent/guardian 2 to student:

MotherFatherGuardianOther
Parent/Guardian 2 address (if different from student):
Parent/Guardian 2 email:
example@example.com
Parent/Guardian 2 employer:
Parent/Guardian 2 work phone:
Please enter a valid phone number.
Child lives with (check all that apply):*

Mother & FatherMotherFatherMother & StepfatherFather & StepmotherGrandparentGuardianOther
If divorced or single, who has custody of the child?:

Joint CustodyMotherFatherOther
Do you have legal custody/placement/guardianship paperwork to share with the office? (If yes, please provide a copy of the most recent paperwork to keep on file with the office).*

YesNo
EMERGENCY CONTACTS

Someone we can contact if we cannot reach you - contact must be 18+
Emergency contact 1 name:

First NameLast Name
Relationship of emergency contact 1 to student:

GrandparentAunt/UncleFamily friendOther
Emergency contact 1 phone:
Please enter a valid phone number.
Can emergency contact 1 pick up your student from school?

YesNo
Emergency contact 2 name:

First NameLast Name
Relationship of emergency contact 2 to student:

GrandparentAunt/UncleFamily friendOther
Emergency contact 2 phone:
Please enter a valid phone number.
Can emergency contact 2 pick up your student from school?

YesNo
Access ID Information

*If you answer "yes" to either of the following questions, you should have an existing PowerSchool account. If you do not remember your account information, please let someone in the office know and we will assist you.
Do you have any students currently enrolled/attending a school or program in West De Pere?*

YesNo
If yes, please list your student's name & grade:

Student 1 : First & last nameGrade
If you have another student attending WDP, please list that student's name & grade:

Student 2 : First & last nameGrade
If you have another student attending WDP, please list that student's name & grade:

Student 3 : First & last nameGrade
If you have another student attending WDP, please list that student's name & grade:

Student 4 : First & last nameGrade
Have you previously enrolled a student (who is not a current student) in a school program in West De Pere (prior to the 25-26 school year)?:*

YesNo
If you answered yes, please list your student's name:

First & last nameLast Name
*If you answered "no" to both of the previous questions, please enter your preferred username for your PowerSchool account:
Do you need an additional PowerSchool account created for another parent/guardian?:

YesNo
If you do need an additional PowerSchool account created, who is the account for?:

First & last namePreferred username of second account
Previous School Information

We will use this information to request your student's records from the school they are transferring from (if they previously attended a school).
Did your student attend a school prior to the 2025-26 school year?:*

YesNo, Hemlock Creek will be the first school my student will attendMy child was homeschooled through the DPI
What is the name of the school your student(s) is transferring from?:*
What is the fax number of your student(s)'s previous school?:
Please enter a valid phone number.
Previous School Location:*

City of former school

Street Address Line 2

State of former schoolState / Province

Postal / Zip Code
Census Information

All census information remains confidential.
What municipality do you currently reside in?:*

City of De Pere (08)Township of Lawrence (50)Village of Hobart (51)Township of Oneida (52)Village of Ashwaubenon (53)
What county do you currently reside in?:*

Brown CountyOutagamie County
Is the home address you previously entered the same address you lived at during April of 2024?:*

YesNo
If you answered no to the previous questions, please provide the address you moved from:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

(Child/Children Information - list all family members between the ages of 0-20 (that reside in the household). Please list the information that would be for the 2025-26 school year. *

	Name (First, Middle Initial, Last)	Sex	DOB	Grade (for the 2025-26 school year)	School (for the 2025-26 school year)	Ethnicity	Handicap Impairment (List any handicapping impairments you may be aware of)
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6

Completion signature:
Name of parent/guardian completing the registration:*
Date of completion:*

MonthDayYear
Date
Should be Empty:

Student Information

Student's Birth Certificate Information

Parent/Guardian Information

EMERGENCY CONTACTS

Access ID Information

Previous School Information

Census Information

Completion signature: