School Application Form

Fort Worth Save Our Children

Application for Enrollment
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Place of Birth
Gender
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level
School Year
School Last Attended
Parent/Guardian's Information
Parent/Guardian's Name - Primary

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian's Name - Secondary

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child Pick Up Authorization

First Name, last nameRelationship to the student
phone number
Please enter a valid phone number.Format: (000) 000-0000.
Child Pick Up Authorization

First Name, last nameRelationship to the student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child Pick Up Authorization

First Name, last nameRelationship to the student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Required Records upload:

Attach all of the following documents:Report card from the previous school, medical clearance from doctor to attend school, and Current shot records.
Upload
Health History
If the student have any allergies, please list them down below:
Does the student currently taking any medications? If yes, please list them down below:
Does the student have any medical conditions that you would like to declare?
Does your child have any diagnosed learning disabilities or special education needs (e.g., ADHD, dyslexia, autism spectrum disorder, speech/language delays, etc.)?
Emergency Medical Authorization
Authorization for Emergency medical: In the event that I cannot be reached to make arrangements for emergency medical attention I authorize this facility director or person in charge to take my child to:
Name

physicianaddress
hospital phone
Date Signed

MonthDayYear
Date
Parent/Guardian Signature
Date Signed

MonthDayYear
Date
Parent/Guardian Signature
Should be Empty:

Fort Worth Save Our Children

Parent/Guardian's Information

Required Records upload:

Health History

Emergency Medical Authorization