USD 245 K-12 Enrollment Form **IN-DISTRICT NEW STUDENTS**
USD 245 Student Registration Information: The following form will serve as an electronic registration for your student(s). Registration must be filled out completely by a parent or guardian. If you have questions, please call: USD 245 District Office 620-964-2212, SCCHS/SCCMS 620-964-2217 or SCCES 620-836-2151. DO NOT list any PRESCHOOL students on this form. To enroll a PRESCHOOL student, please use the PRESCHOOL Enrollment form.
Please list your student(s) full name (first, middle, last).
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ex: Jane Irene Doe
Please list the student(s) first name followed by their date of birth (MM/DD/YYYY).
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ex: Jane 12/10/2005
Please list the student(s) first name followed by their social security number.
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ex: Jane - 555-55-5555
Please list your students first name and the grade they will be attending during the 2025-2026 school year.
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ex: Jane - 5th Grade
Does your student(s) have an IEP?
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Please Select
Yes
No
If you answered "yes" above, please list the first name of the student(s) who have an IEP.
Ethnicity?
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Please Select
White
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
Hispanic
Please list your student(s) name(s) followed by the gender they were assigned at birth.
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ex: Jane - female
Does your student(s) have any allergies or other health concerns we should be made aware of?
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Please Select
Yes
No
If you answered "yes" to the question above, please explain below.
Will your student(s) need any meal modifications?
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Please Select
Yes
No
If you answered "yes" to the above question, please explain below.
Home Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list the parent/guardians first and last name(s) followed by their contact number.
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ex: John Doe 888-555-1234
Please provide a frequently checked email address of a parent/guardians.
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example@example.com
Please list the parent/guardians name followed by their employer and employer contact number.
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ex: John - Evergy - 888-555-5555
Please list the names, relationship to student and phone numbers of EMERGENCY contacts for your student(s) if the district is unable to reach the parent/guardian.
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ex: Julie Doe - grandmother -888-555-8749
If you live more than 2.5 miles from the nearest attendance center, will your student(s) need to be added to the bus route schedule?
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Please Select
Yes
No
N/A
Will your student(s) be riding the shuttle bus? The shuttle bus takes students to their attendance center if they reside in the opposite town that they attend.
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Please Select
Yes
No
Unknown
Please list the name of your health insurance provider along with the policy number. The district would also appreciate a copy of your insurance card to have on file. Incomplete information will not be accepted.
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ex: BCBS - XYZ123456
Preferred Hospital Name:
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ex: Coffey County Hospital
Preferred Physicians name and phone number:
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ex: Dr. Downs - 888-555-5235
Liability of Medical Expenses Waiver: I give permission for my children to participate in field trips and other activities authorized by USD 245. Further, I give my legal consent and authorize any representative of USD 245 to authorize emergency medical treatment, including any necessary surgery or hospitalization, for my child(ren) listed above for any injury or illness of and emergency nature he/she incurred while participating in the field trip or other activity by any physician or dentist in accordance with the provisions of the Kansas Healing Arts Act, K.S.A. 650-2801 and any hospital.
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Please Select
Yes
No
Annual Notice of Authorized Student Data Disclosures: I give permission for USD 245 to post on the district website and the district Facebook page information about my child(ren) including student articles, photos, stories, and information on student life submitted by teachers, coaches, newspaper and yearbook staff. Students will be identified by first and last name all USD 245 schools. (Staff periodically submit articles and pictures to the local Newspapers, pictures and /or names may appear in the newspaper without parent consent.
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Please Select
Yes
No
Computer Use Agreement: My child understands and will abide by the district guidelines and conditions for the use of the facilities of USD 245 public schools and access to the internet. I further understand any violation of the district guidelines Computer Use Policy is unethical and may constitute a criminal offense. Should my child commit any violation, my child’s access privileges may be revoked. School disciplinary action and/or appropriate legal action may be taken.
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Please Select
Yes
No
Kansas regulations now require that district provide all parents with notice of our written policies regarding Emergency Safety Interventions (“ESI”). Our policy is available on our website at USD245ks.org. Please feel free to download and print it at your convenience.
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Please Select
I have read and understand where to find ESI
Other
Have you downloaded the USD 245 app? If not, it can be downloaded through Google Play Store or the Apple App Store. Make sure your notifications for the app are turned ON! This is how we will be communicating school closures and much more.
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Please Select
I have read and understand where to download the app and to turn on the notifications.
Other
This section is ONLY for SCCHS students. SCCHS students have the opportunity to participate in various activities during the school year that take them off the school grounds during the school day, but where transportation is not directly provided by USD 245. Examples of this would be: student work study and traveling to businesses in town for supplies for school projects, etc. In order for student to participate in these types of activities, we need the following transportation release on file along with a copy of their driver’s license if they are 17. Off campus lunch is not included with this waiver. If students plan to eat lunch off campus they must walk or be picked up by an adult. I hereby give permission for my son/daughter to drive to and from school related events, when approved by administration, in their personal vehicle.
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Please Select
Yes
No
My student(s) are not in High School
I understand that the submission of this form serves as my “electronic” signature and replaces a hand written signature in all questions answered above.
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Please Select
Yes
No
Please list your First/Last name below along with your last 4 SS #digits. This indicates that you are the legal guardian of the above mentioned student and are the person filling out this form.
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Submit
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