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ANDERSON COUNTY SCHOOLS Enrollment Packet

STUDENTS I AM REGISTERING TODAY First Name Last Name School Grade

PARENT/GUARDIAN CONTACT INFORMATION First Middle Last Relationship Work/Home Phone Cell Phone

*Place a checkmark next to parent/guardians the student lives with. EMERGENCY CONTACTS/CHECK-OUT CONSENT First Middle Last Relationship Home Phone Work Phone Cell Phone

STUDENTS ALREADY ENROLLED IN ANDERSON COUNTY SCHOOLS First Name Last Name School Grade

Household Information Page 1 of 3 Last Updated on 5/31/2018 Household Information

Primary Household (This is the address where the students above reside.)

Physical Address NUMBER STREET APT/LOT

CITY STATE ZIP Mailing Address (if different) P.O. BOX (OR OTHER MAILING ADDRESS)

CITY STATE ZIP (Check if Unlisted) Home Phone ______

Parent or Guardian 1 (This is the primary parent/guardian for the students listed above.)

Name FIRST MIDDLE LAST

Employer ______Work Phone ______

Cell Phone ______Email Address______

Parent/Guardian Legal Guardian (by court) Stepparent Foster Parent Other (specify)______

Parent or Guardian 2 (This is either the second parent/guardian or a step-parent living in the household.)

Secondary Household (This section should be completed if both parents do not live in the Primary Household.)

Physical Address NUMBER STREET APT/LOT

CITY STATE ZIP Mailing Address (if different) P.O. BOX (OR OTHER MAILING ADDRESS)

CITY STATE ZIP (Check if Unlisted) Home Phone ______Household Information Page 2 of 3 Last Updated on 5/31/2018

Parent or Guardian 3 (This will generally be a parent who does NOT live in the Primary Household with the students.)

Parent or Guardian 4 (This will generally be the individual living with a parent in a Secondary Household.)

District Services Survey (The following will help determine if you are eligible for additional services.) Employment Survey Have you or your family moved from one town or school district to another Yes No within the state or out-of-state within the past three years? Did the children in your family join you at a later date after you Yes No moved? During the last three years, were any of these moves made with the intent to Yes No find temporary or seasonal work in farming/agricultural work? Check all that apply: Working on a farm Working in tobacco Working in tobacco green house Milking cows Working with beef cattle Working in a plant nursery/greenhouse Working in a processing plant Working on a poultry farm Picking fruits or vegetables Tree growing or harvesting Student Residency Survey Do your children live with friends or family members in a home in which their Yes No parents/guardians don’t live? Do your children live with more than one family in a house or apartment? Yes No Do your children live in a motel, car, or campsite? Yes No Do your children live in a shelter? Yes No Home Language Survey Is your child’s first-learned language anything other than English? □ Yes □ No If you answered “Yes” to the question, please answer the following. Which language did your child learn when he/she first began to talk? ______What language does your child most frequently speak at home? ______

Household Information Page 3 of 3 Last Updated on 5/31/2018 What language do you most frequently speak to your child? ______

Household Information Page 4 of 3 Last Updated on 5/31/2018