OYSTER RIVER COOPERATIVE SCHOOL DISTRICT

School Registration Form

   

Today’s Date: __________________ Entering Grade:  9      10     11      12     

                             

 

Students Name: ____________________________________________________________________________________           

                                        First                                                                            Middle                                                                 Last  

 

Male     Female     Date of Birth: ________________________   Place of Birth: _____________________________

                                                               Month                Day                   Year

 

Homes Address: ____________________________________________________________________________________

                                                       Street                                                                                   City                                                                                 State

 

Home Phone No.: _______________________  

 

Name and Address of school student last attended: _________________________________________________________

                                                                                                                                                           

 

Name of Primary Parent/Guardian: _____________________________ Place of work: ___________________________

 

Work Phone Number: ___________________________ Cell Phone Number: __________________________________                                                                                   

 

E-mail address: _________________________________________________   Send school notices by e-mail?  Yes     No

 

 

Name of Secondary Parent/Guardian: ___________________________________________________________________

 

Home Address: _____________________________________________________________________________________

 

Home Phone Number: ____________________________Place of work: _______________________________________     

 

Work Phone Number: ___________________________ Cell Phone Number: __________________________________

 

E-mail address: _________________________________ Send school notices by e-mail?  Yes     No

 

 

Other children in the student’s family:

            Name                                     Grade                                           Name                                                              Grade

1. __________________________________________               4. ____________________________________________

2. __________________________________________               5. ____________________________________________

3. __________________________________________               6. ____________________________________________

 

Health Information:

 

Does your child have health issues?  No   Yes   If yes, what?                                                         

 

Is there anyone working with you on these issues?  No    Yes   If yes, whom?                                 

 

Is it possible the school will need to make any accommodations for your child?  No   Yes   If yes,

please explain. _____________________________________________________________________________________       

                                                                                                                            

 

Which of the following special services has your child received?

 

Resource Rm.                        Occupational Therapy                        Speech/Language                        ESL    

 

Please explain the reasons for the above service(s) and when/where they were provided: ___________________________

 

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