LA CRESCENT SECONDARY REGISTRATION STUDENT FORM

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1 LA CRESCENT SECONDARY REGISTRATION STUDENT FORM Student Last Name First Name Middle Name Grade Sex Birthdate Primary Language Spoken at Home Student s Cell Phone Number Student s Address Race/Ethnic Heritage: American Indian Asian or Pacific Islander White not of Hispanic origin Black not of Hispanic origin Hispanic (circle one: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, White) Does student have an IEP or 504? Last School Attended Name Mailing Address City, State, Zip Parent(s) and/or Legal Guardian Student Lives With Name: IMPORTANT! Has this student attended any school in Minnesota prior to enrolling at La Crescent-Hokah? If yes, what school and city? Have you recently moved to this school district within the last 36 months for temporary or seasonal agricultural or fishing work? Date (Parent/Guardian Signature) Student s Birth Certificate MARSS INFORMATION (To be filled out by La Crescent Seconedary School): Resident district State Aid Category Enrollment code Entry date Marss ID Number Student ID Homeroom advisor Locker number Student Name: Grade:

2 1. Has your child ever been expelled: Yes No If yes, dates of expulsion: 2. Has your child ever been asked to leave a school district in lieu of expulsion: Yes No Explain: 3. Does your child have a County Social Worker or Probation Officer or do you have a Family Advocate assigned? Yes No Final enrollment approval is determined by the Superintendent or his designee. Guardian or Custodial Parent Signature: Date:. ADMINISTRATIVE REVIEW Approved for enrollment Denied for enrollment Comments: Administrator s Signature: Date:

3 School District of La Crescent - Hokah Parent Information In order to verify residency within the La Crescent - Hokah School District, one current document from the following list must be provided. Said documents must show parent/guardian/caregiver name and address. Past due bills are not acceptable for verification. Post Office box numbers are not acceptable as residence addresses. Students will not be enrolled unless proof of address is verified. Current Address: Effective Date of Move: For proof of residence any of the following documents: Escrow papers, mortgage book or statement Homeowner s association fees statement Lease Agreement/Rental Contract and current rent receipt Letter on apartment complex or mobile home park letterhead, signed by the landlord, stating that parent/guardian/caregiver lives there (mandatory with 2nd Family Affidavit) Gas & Electric Bill Water Bill Sewer Bill Trash Bill Verification of Social Services (SSI, AFDC, Medi Cal) I, _ (print name) the parent/guardian/caregiver/other* of the below-named student(s) resides at the address shown on the document indicated above and attached. I agree to notify the district office within two weeks if residency changes and agree to provide a new residency proof and updated signed statement at that time. If I move outside the school district, an open enrollment form or a tuition agreement must be completed in order to request continued attendance for this student. Student Names: Warning:Falsification of any information or document required for residency verification or the use of the address of another person without actually residing there may result in revocation of student enrollment. Parent/Guardian/Caregiver/Other* Signature: * Other indicates Persons living with another family, second verification form required. Date: FOR SCHOOL USE ONLY: The attached document/s show/s the name and address of the person/s enrolling the above named student. If not the parent, court papers are required for guardianship, foster license for foster parent, caregiver affidavit for caregiver. Signature of School Official: Date:

4 Family 1 - Parent(s) and /or Legal Guardian Student Lives With - (With Proof of Residency) Street Address Mailing Address City, State, Zip Home Phone #: Parent/Guardian 1 Name: Relationship to Student(s) Parent/Guardian 2 Name: Relationship to Student(s) Family 2 - Other Parent(s)/Legal Guardian Street Address Mailing Address City, State, Zip Home Phone #: Parent/Guardian 1 Name: Relationship to Student(s) Parent/Guardian 2 Name: Relationship to Student(s)

5 RELEASE OF STUDENT RECORD INFORMATION Student's Name Year of Graduation Current grade Birthdate The undersigned hereby authorizes the release of his/her transcript of subjects taken, grades received, health and immunization records, records of attendance, rank in class, grade point average, standardized test results, college admissions test results, date of graduation, individualized education plans and other pertinent data. The information is to be sent TO: La Crescent Secondary School Student Records 1301 Lancer Blvd. La Crescent, MN The information is to be sent FROM: (School, College, Business, Individual) (Person in charge of these records) (Mailing address) (City, State, Zip) Date (Student Signature-if over 18) Date (Parent Signature-if student is under 18) Registration and emergency forms

6 LACRESCENT MIDDLE SCHOOL REGISTRATION GRADE 8 After discussing your choice of classes with your parents, please rank the classes listed below with one being your first choice. If you don t have an instrument please cross out band, no need to rank: Choir Band Art PARENT OR GUARDIAN MUST SIGN THIS FORM. Student Name Advisor Parent Signature Phone Number (H) (W) address:

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