Garden Plain Elementary School

Please Fill Out The New Student Enrollment Form Below

Child #1

Child's Legal First Name

Child's Middle Name

Child's Legal Last Name

Child's Preferred Name

Gender

Reaquired field: Female

Reaquired field: Male

Date of Birth:

Grade Entering for 24-25

Hispanic/Latino?

Reaquired field: Yes

Reaquired field: No

Race (check all that apply)

Reaquired field: American Indian or Alaska Native

Reaquired field: Asian

Reaquired field: Black or African American

Reaquired field: Native Hawaiian/ Pac. Islander

Reaquired field: White

Does this student have an IEP?

Yes

Child #2

Child's Legal First Name

Child's Middle Name

Child's Legal Last Name

Child's Preferred Name

Gender

Female

Male

Date of Birth:

Grade Entering for 24-25

Hispanic/Latino?

Yes

Race (check all that apply)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian/ Pac. Islander

White

Does this student have an IEP?

Yes

Child #3

Child's Legal First Name

Child's Middle Name

Child's Legal Last Name

Child's Preferred Name

Grade Entering for 24-25

Date of Birth:

Gender

Female

Male

Hispanic/Latino?

Yes

Race (check all that apply)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian/ Pac. Islander

White

Does this student have an IEP?

Yes

Student resides with:

Reaquired field: Both Parents

Reaquired field: Mother

Reaquired field: Father

Reaquired field: Shared Custody

Reaquired field: Guardian

Reaquired field: Other

Mother's First and Last Name:

Mother's Email Address

Mother's Cell Phone Number

Reaquired field: Mother's address:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Mother's Place of Employment

Mother's Work Number

Father's First and Last Name:

Father's Email Address

Father's Cell Phone Number

Father's Address: (If different from Mom)

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Father's Place of Employment

Father's Work Phone Number

Emergency Contact #1

Relationship

Grandmother

Grandfather

Sibling

Daycare

Other Relative

Phone Number

Emergency Contact #2

Relationship

Grandmother

Grandfather

Sibling

Daycare

Other Relative

Phone Number

Physician Name

Physician Phone Number

Preferred Hospital

Medical Notes

Email a copy to

optional

Required Fields

Garden Plain Elementary

New Student Enrollment Form

NEW STUDENT ENROLLMENT FORM

2024-25 School Year

New Families ONLY