Fort Worth Save Our Children
Application for Enrollment
Student Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Place of Birth
Gender
Male
Female
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade Level
School Year
School Last Attended
Parent/Guardian's Information
Parent/Guardian's Name - Primary
First Name
Last Name
Occupation
Phone Number
Please enter a valid phone number.
Parent/Guardian's Name - Secondary
First Name
Last Name
Occupation
Phone Number
Please enter a valid phone number.
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person
First Name
Last Name
Emergency Phone Number
Please enter a valid phone number.
File Upload
Please upload these items: Report card from the previous school, medical clearance to attend school, 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.)?
Date Signed
-
Month
-
Day
Year
Date
Parent/Guardian Signature
Submit
Submit
Should be Empty: