Andale Elementary School

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New Student Enrollment Form

2018-19 School Year

New Families ONLY

Welcome to AES!

Please Fill Out The New Student Enrollment Form Below

Child #1

Legal First Name

Middle Name

Legal Last Name

Preferred Name

Gender

Reaquired field: Female

Reaquired field: Male

Date of Birth:

Grade Entering 2018-19

Does this student have an IEP?

Reaquired field: No

Reaquired field: Yes

Child #2

Legal First Name

Middle Name

Legal Last Name

Preferred Name

Gender

Female

Male

Date of Birth:

Grade Entering 2018-19

Does this student have an IEP?

Yes

Child #3

Legal First Name

Middle Name

Legal Last Name

Preferred Name

Gender

Female

Male

Date of Birth:

Grade Entering 2018-19

Does this student have an IEP?

Yes

Primary Household

Home Street Address

Apt. #

City

Zip Code

Student(s) resides with:

Reaquired field: Both Parents

Reaquired field: Mother

Reaquired field: Father

Reaquired field: Other

Primary Parent #1

Relationship

Reaquired field: Father

Reaquired field: Mother

Reaquired field: Step Father

Reaquired field: Step Mother

Cell Phone

Email Address

Place of Employment

Work Phone

Primary Parent #2

Relationship

Father

Mother

Step Father

Step Mother

Cell Phone

Email Address

Place of Employment

Work Phone

Alternate Household

Home Street Address

Apt. #

City

Zip Code

Alternate Parent #1

Relationship

Father

Mother

Step Father

Step Mother

Cell Phone

Email Address

Place of Employment

Work Phone

Alternate Parent #2

Relationship

Father

Mother

Step Father

Step Mother

Cell Phone

Email Address

Place of Employment

Work Phone

Emergency Contact #1 Name

Phone Number:

Relationship to Child:

Emergency Contact #2 Name:

Phone Number:

Relationship to Child:

Physician Name

Physician Phone Number

Email a copy to

optional

Required Fields