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    Mannsdale Elementary School

      Registration Information

     

    Student Name_________________________________________________________________________________

                                                 Last                                                            First                                                         Middle

    Preferred Name:______________________________                      Social Security Number______-______-______                                             

    Race(circle):    B     W     A     H     Native American     Other__________                 Gender (circle)        M        F

     

    Date of Birth: ________________________________                    Grade: _________________________________

     

    Street Address_______________________________________City_________________Zip___________________

     

    Subdivision___________________________________     Own/Lease:__________     Lease expires:____________

     

    Student lives with (check all that apply): ____ Mother ____Father  ____Stepfather ____Stepmother ____Other

     

    Mother/Guardian Name_________________________________________________________________________

     

    Address if different from child ____________________________________________________________________

     

    Home Phone ____________________     Work Phone____________________     Cell Phone___________________

     

    Place of Employment ________________________________________     Occupation________________________

     

    E-Mail Address_________________________________________________________________________________

     

    Father/Guardian Name__________________________________________________________________________

     

    Address if different from child ____________________________________________________________________

     

    Home Phone ____________________     Work Phone____________________     Cell Phone___________________

     

    Place of Employment ________________________________________     Occupation________________________

     

    E-Mail Address_________________________________________________________________________________

     

    Siblings, grade, DOB,  and school: ___________________________   _____   __/__/__   _____________________

                                                                  ___________________________   _____   __/__/__   ______________________

                                                                  ___________________________   _____   __/__/__   ______________________

     

    Pre-School:    ____Yes    ____No        Name of school attended: _________________________________________

     

    Special Services (circle):       Gifted                    SPED – IEP                             Speech – IEP                         ELL

     

    Emergency numbers and individuals authorized to check out:

     

    1.       __________________________________Relationship _________________  Phone #_________________

     

    2.       __________________________________Relationship _________________  Phone # ________________

     

    3.       __________________________________Relationship _________________  Phone # ________________

     

    *****DO NOT RELEASE CHILD TO:________ (Please provide legal documentation)______________________

    _____ Yes, my child’s name, address & phone number may appear in the school directory.

     

    _____ No, my child’s name, address and phone number may not appear in the school directory.
     
     

     

    Mannsdale Elementary School

    Registration Information

     

    Student Name___________________________                 Teacher_____________________

     

    Did your child attend pre-school? (Circle one)                              YES                          NO

     

    If yes, name of pre-school attended:____________________________________________________________

     

    Does your child currently take a daily nap? (Circle One)             YES                          NO

     

    If yes, for how long? _________________________________________________________________________

     

    To help us in the placement of your child, please tell us a little more about your child.

     

    ·         PERSONALITY:

     

     

     

     

     

     

    ·         LEARNING STYLE(S):

     

     

     

     

     

     

    ·         SOCIAL SKILLS:

     

     

     

     

     

     

    ·         ACADEMIC STRENGTHS:

     

     

     

     

     

     

    ·         ACADEMIC WEAKNESSES:

     

     

     

     

     

     

    ·         OTHER