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Legal Name on Birth Certificate:
First:
Middle:
Last:
Preferred Name:
Date of Birth:
Age on Sept 1st:
Gender:
MaleFemale
Current Address (No P.O. Box):
Race (Check all that apply):
AsianBlackNative Hawaiian/Pacific IslanderHispanic/LatinoWhite/CaucasionAlaska Native/American Indian-Tribe
Last School Attended:
17/18* Grade:
Main Contact #:
Is this student placed in the grade indicated by age?
YesNo Explain:
CUSTODIAL PARENT INFO
Parent Name:
MotherFatherGuardian
Address (If different from above):
Email:
Work Place:
Main #:
Work Phone:
Alternate #:
CUSTODIAL PARENT INFO
Parent Name:
MotherFatherGuardian
Address (If different from above):
Email:
Work Place:
Main #:
Work Phone:
Alternate #:

Student Lives With:
Both ParentsMother OnlyFather OnlyMother/StepfatherFather/StepmotherGuardian

NON-CUSTODIAL PARENT INFO (IF APPLICABLE)
Name:
Address:
Email:
Does the non-custodial parent have visitation rights?
YesNo
Is there a court decision that the non-resident parent should NOT receive school information or attend school activities?
YesNo
***Please attach a certified copy of the court decision establishing a custody or guardianship and include those sections referring to visitation rights and contacts with the school. Also include the page bearing the judge's signature and court seal. This copy should include any and all modifications made as of the date of registration of the child in this school. It is also the responsibility of the parents to inform the Director of any subsequent modifications during the child's tenure at the school.
FAMILY DYNAMICS
Sibling:
age:
Sibling:
age:
Sibling:
age:
Sibling:
age:
Sibling:
age:
Sibling:
age:
SELECT THE STATEMENT BELOW WHICH BEST DESCRIBES YOUR RELATIONSHIP TO THE STUDENT:
I am the parent (Birth or Adopted) of this child and the CHILD LIVES WITH BOTH PARENTS.I am the parent (Birth or Adopted) of this child and AM NOT CURRENTLY MARRIED TO THE OTHER PARENT, but I have been awarded physical legal custody through the court.I am NOT the parent (Birth or Adopted) of this child. I am a RELATIVE OR FRIEND and have been awarded legal guardianship.I am a FOSTER PARENT or PROCTOR PARENT.
PAPER COPIES OF THE BELOW FORMS CAN BE SUBMITTED TO THE SGA ADMINISTRATION OFFICES IN PERSON
ATTACH BIRTH CERTIFICATE:
ATTACH CURRENT IMMUNIZATION RECORDS OR EXEMPT FORM:
ATTACH A COPY OF CURRENT IEP FOR SPECIAL EDUCATION STUDENTS. ONLY (IF APPLICABLE):
ATTACH A COPY OF THE COURT DECISION ESTABLISHING A CUSTODY OR GUARDIANSHIP AND INCLUDE THOSE SECTIONS REFERRING TO VISITATION RIGHTS AND CONTACTS WITH THE SCHOOL. ALSO INCLUDE THE PAGE BEARING THE JUDGE'S SIGNATURE AND COURT SEAL. THIS COPY SHOULD INCLUDE ANY AND ALL MODIFICATIONS MADE AS OF THE DATE OF REGISTRATION OF THE CHILD IN THIS SCHOOL. ONLY (IF APPLICABLE):
SIGNATURE OF PARENT/LEGAL GUARDIAN:
DATE: