Sifa - Registration Form SY 2025

Beehively ID (Student)
Beehively ID (Parent)
Entering grade:
Previous school:
Student Information
Student's Name

First NameMiddle NameLast Name
Gender
Age
Grade
Social Security
Date of Birth

MonthDayYear
Date
Place of Birth (City, State)
Forms & Documents to be Submitted:
Registration Form

Cancelof
COPY of Birth Certificate or Passport

Cancelof
School Records/Current Transcripts/IEP/Behavioral Recordsvia Email (official Withdrawal from previous school)

Cancelof
Report Card (Most Recent)

Cancelof
Updated Annual Physical Examination Form:

Cancelof
UPDATED Immunization Record (with Annual PPD orclearance from DPHSS, if positive)

Cancelof
If applicable: Notarized Legal Guardianship Documents orNotarized Power of Attorney

Cancelof
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Citizenship

Other
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Has the student attended SIFA Learning Academy Charter School in the past?
Does the student have a sibling that attended and/or is currently attending SIFA LACS?
If yes, please provide their name(s):
Sibling’s 1 Full Name

First NameMiddle NameLast Name
Sibling’s 2 Full Name

First NameMiddle NameLast Name
Sibling’s 3 Full Name

First NameMiddle NameLast Name
Parent Information
First Parent - Relationship to student
Will be MAIN PARENT
Name

First NameMiddle NameLast Name
Home Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone (if different from above)
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Occupation
Employer
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Marital Status
Check all that apply to FIRST Parent:
Second Parent - Relationship to student
Name

First NameMiddle NameLast Name
Home Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone (if different from above)
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Occupation
Employer
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Marital Status
Check all that apply to SECOND Parent:
Legal Guardian – Relationship to Student
Please provide a Notarized Legal Guardianship Document or Notarized Power of Attorney if thestudent is not residing with natural parents.
Name

First NameMiddle NameLast Name
Home Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone (if different from above)
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Occupation
Employer
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Marital Status
Check all that apply to Legal Guardian:
Student Medical Information
Medical History:
Does your child have any health issues? If yes, please specify:
If yes, please specify:
Please indicate which of the following communicable disease(s) the student has had:
Please indicate whether the student has any persistent problems with the following:

Other
Does the student take any special medication(s) for it?
If yes, please specify what medication(s):
Is the student up to date with his/her immunizations?
If yes, please specify:
Has the student had any serious accidents that required him/her to be hospitalized?
If yes, please specify:
Has the student had any operations?
If yes, please specify:
Does the student wear glasses?
Date of last eye exam:

MonthDayYear
Date
Does the student have regular dental checkups?
Date of last dental check-up:

MonthDayYear
Date
Does the student have any hearing problems?
Date of last hearing exam:

MonthDayYear
Date
Does the student have any allergies?
If yes, please specify:
Does the student have any allergies to medicine?
If yes, please specify:
Long-term medications prescribed by a Medical Doctor?
If yes, please specify:
Short-term medications (e.g., pain relievers, antibiotics)?
If yes, please specify:
** Need Parental Consent for the School Nurse or designated personnel to dispense such medication. **
Does the student receive any instructional support or accommodations that the school should be made aware of to best support their learning?(e.g., IEP, 504 Plan)
If yes, please specify and provide all supporting documents:
Student & Parent Demographics
1. What is the student’s birth mother’s race?

Other
2. What is the student’s birth father’s race?

Other
3. What language did the student speak when the student first began to talk?

Other Language
4. What language does student speak most frequently at home?

Other Language
5. What language do parents (or primary adult care giver) mostly frequently speak to student with?

Other Language
6. What language does student most frequently speak to friends with?

Other Language
7. Student is living with:

Other
8. (1) Parent(s) Educational Background: Highest education completed. (Mother/Primary Care-giver #1)
8. (2) Parent(s) Educational Background: Highest education completed. (Father/Primary Care-giver #2)
9. (1) Which of the following best describes your current status?(Mother/Primary Care-giver #1)
9. (2) Which of the following best describes your current status?(Father/Primary Care-giver #2)
10. Other information for Mother/Primary Caregiver #1:
Place of Employment:
Job Title:
Has this parent ever served or is serving in the military?
If yes, what branch of the military?
Is this individual a Veteran of Foreign Wars (VFW)?
Is this individual a retired veteran?
11. Other information for Father/Primary Caregiver #2
Place of Employment:
Job Title:
Has this parent ever served or is serving in the military?
If yes, what branch of the military?
Is this individual a Veteran of Foreign Wars (VFW)?
Is this individual a retired veteran?
12. Total Annual Household income (to include all sources of wages, veterans benefits, child support, unemployment benefits, disabilities, retirement, etc...). This should be the household of the student’s primary living situation.

Not sure
13. Does the child’s primary household receive government assistance?
If yes, what type of assistance is the household receiving? (Mark all that applies)

Other

14. Number of people currently living in your household, including individual filling out form:

Rows	People Number
# of adults (ages 18+)
# of adults considered dependents
# of adults contributing to household
# of children (ages 0-17)

15. (1) Information regarding living arrangements:Live in a house (if answer, check one below)

Other
15. (2) Information regarding living arrangements : Live in an apartment/condo (if answer, check one below)

Other
16. How long have you lived in this current residence?
Emergency Information
Student Name
Grade
- In case of emergency, the school immediately contacts the parents. If parents are not available, please provide the information below for the name(s) of the person(s) to contact.
- The individuals listed below will have authority to pick up the student from school.
No. Emergency Contact Information
Emergency Contact 1
Name

First NameMiddle NameLast Name
Relationship to the child
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2
Name

First NameMiddle NameLast Name
Relationship to the child
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 3
Name

First NameMiddle NameLast Name
Relationship to the child
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 4
Name

First NameMiddle NameLast Name
Relationship to the child
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 5
Name

First NameMiddle NameLast Name
Relationship to the child
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Physician Name
Hospital/Clinic
Hospital/Clinic Phone
Please enter a valid phone number.Format: (000) 000-0000.
Does the student have medical insurance?
If yes, please specify:
Parent Name

First NameLast Name
Signature
Date

MonthDayYear
Date
Parent Name

First NameLast Name
Signature
Date

MonthDayYear
Date
Student Name
Student Name
MEDIA RELEASE CONSENT FORM
SIFA Learning Academy Charter School will be holding activities that will be used for school promotion which we simply call “SIFA Promotion”. SIFA Promotion has the purpose of making SIFA known in Guam and beyond. A variety of media shall be used including but not limited to commercials and promotions (tv, radio, internet), billboards, newspapers and magazines, social media, brochures, etc.
Student Name

First NameMiddle NameLast Name
Grade
By signing this Media Release Consent Form:
1. I give permission for SIFA Learning Academy Charter School to take and use photographs, video, or audio recordings of my child for school promotional purposes, including but not limited to printed materials, social media, websites, and local media.
2. I understand that these photos or recordings may be edited, used, or shared by SIFA Learning Academy CharterSchool for school-related purposes, and that neither my child nor I will receive compensation.
3. I understand that SIFA Learning Academy Charter School will use these materials responsibly and for the purpose of promoting school activities, programs, and events.
4. Revoking Permission: I may revoke this permission at any time by submitting a written request to the school. Revocation will apply to future use only and will not require SIFA Learning Academy School to remove or retract materials already published or printed.
5. I release SIFA Learning Academy Charter School from any claims related to the appropriate use of my child’s photo, video, or audio recordings for school promotional purposes.
Parent(s)/Guardian Name

First NameLast Name
Signature
Date

MonthDayYear
Date
Should be Empty:

Student Information

If yes, please provide their name(s):

Parent Information

Student Medical Information

Student & Parent Demographics

10. Other information for Mother/Primary Caregiver #1:

11. Other information for Father/Primary Caregiver #2

Emergency Information

Emergency Contact 1

Emergency Contact 2

Emergency Contact 3

Emergency Contact 4

Emergency Contact 5

MEDIA RELEASE CONSENT FORM