Student Enrollment Form 2011 - 2012

Student's Name First
Middle
Last

Date of Birth Age Male Female Grade to Enter 6 7 8

Student's Address Home Address
Phone
City
State
Zip Code

Present School Present Grade Social Security Number What School District does the student reside in? Does your student have an IEP/504 Plan? Yes No

Has student ever been expelled? Yes No If yes, please explain

1st Parent/Guardian's Full Name
Relationship to Student
Home Address/ if different than student
Home Phone/if different than student
Work Ph Number/Cellular
Email

2nd Parent/Guardian's Full Name
Relationship to Student
Home Address/ if different than student
Home Phone/if different than student
Work Ph Number/Cellular
Email

You will need to provide with this completed form your child's: Birth Certificate, Social Security Card, Immunization Record, and his/her last Report Card.

Signature of Parent/ Guardian
Today's Date
How did you learn about our School? Friend Relative Newspaper TV Radio Drive-by school
Other, please explain:

Admission Procedures

Overview
Student Enrollment Form
Parents' Interest Form

LPCS
Downloads