CELINA ISD REGISTRATION INFORMATION GRADES PK - 12 Parent/Guardian must provide: 1) ______withdrawal form from previous school (if during actual school year, not in summer) 2) ______copy of student’s certified birth certificate* (*if enrolling a child under the age of eleven (11), or if enrolling 1st time in 3) ______student’s current immunization record a Texas public school, no matter what grade level) 4) ______copy of government issued photo ID of person enrolling student (example: driver license) 5) ______indicators of residency: (examples) copy of current utility bill like electric, water, gas or rental/lease agreement of the home you live in within the Celina ISD school boundaries. All documents used to verify residence must include parent/guardian name, current date, and physical address of the home you live in. School personnel will be able to assist you if you have questions regarding proof of residency. Parent/Guardian should provide: 6) ______ copy of student’s social security card, if using the social security number. If not using the student social security number, a state ID number will be assigned. Parent/Guardian are encouraged and may be asked to provide the following: 7) ______copy of student’s last report card 8) ______copy of student transcript from last school district 9) ______STAAR or EOC test scores (if applicable) 10) ______any legal paperwork regarding custody or safety issues for your child * All students enrolling for the 1st time in the district that are under the age of eleven (11) must provide a certified birth certificate and a copy of their immunization records. st ** Students enrolling for the 1 time in a Texas Public School, no matter what grade level, must provide copies of birth certificates and immunization records. All other students that have been in Texas Public Schools in grades 2-12 will be asked to provide this information if it cannot be obtained from their previous school district within 10 days. *** Celina ISD does not accept transfer students. Residency within the Celina ISD school boundaries must be established before the first day of attendance. School personnel will be able to assist you if you have questions regarding residency. Revised December 2017 THIS PAGE LEFT BLANK PLEASE CONTINUE CELINA ISD REGISTRATION FORM: SCHOOL YEAR_________ CAMPUS NAME:___________________________ GRADE LEVEL:__________ STUDENT INFORMATION (Legal name as it appears on birth certificate or Legal name change document.) __________________________________________ _______________________ _________________________________________ ______________ FIRST NAME MIDDLE NAME LAST NAME JR, II, III SOCIAL SECURITY #: ______________________________________ GENDER: MALE OR FEMALE ETHN: _________ DATE OF BIRTH: _______________________________ PLACE OF BIRTH: _______________________________________________________________ STUDENT CELL #: ______________________________ STUDENT E-MAIL: ______________________________________________________________ PHYSICAL ADDRESS (where student sleeps at night): HOME PHONE: _____________________________________ #/STREET: __________________________________________________________ CITY, ST, ZIP: ______________________________________ MAILING ADDRESS: STREET, BOX, APT#: __________________________________________________ CITY, ST, ZIP: ______________________________________ ENROLLING PERSON’S INFORMATION: NAME: ____________________________________________DOB:_____________RELATION TO STUDENT:_________________ STUDENT LIVES WITH: _____PARENT/GUARDIAN 1 OR _____PARENT/GUARDIAN 2 OR _____BOTH PARENTS/GUARDIANS PARENT/GUARDIAN 1 NAME: __________________________________________________________ DOB: ______________ RELATION TO STUDENT: ____________ MAILING ADDRESS: ___________________________________________________________________________________________________________________ E-MAIL ADDRESS: __________________________________________________________ EMPLOYER: _______________________________________ PHONE NUMBERS: CELL: _______________________ HM: _______________________WK: _______________________OTHER: ______________________ PHONE PREFERENCE: (PLEASE CIRCLE) CELL HOME WORK OTHR RIGHT TO TRANSPORT? YES NO PARENT/GUARDIAN 2 NAME: __________________________________________________________ DOB: ______________ RELATION TO STUDENT: ____________ MAILING ADDRESS: ___________________________________________________________________________________________________________________ E-MAIL ADDRESS: ___________________________________________________________ EMPLOYER: ________________________________________ PHONE NUMBERS: CELL: _______________________ HM: _______________________WK: _______________________OTHER: _______________________ PHONE PREFERENCE: (PLEASE CIRCLE) CELL HOME WORK OTHR RIGHT TO TRANSPORT? YES NO EMERGENCY CONTACT AND/OR STUDENT PICK-UP INFORMATION: (OTHER THAN PARENT OR GUARDIAN) 1) NAME: _________________________________________RELATION: _______________PHONE: _____________________RIGHT TO TRANSPORT? __________ 2) NAME:_________________________________________RELATION:________________PHONE:_____________________RIGHT TO TRANSPORT? __________ The above information is required for a permanent school record of my child and will be used by school personnel only. I realize that presenting false documentation, records, or information is a violation of state law and may subject me to tuition costs for my child. I authorize school personnel to contact the person(s) named above if I cannot be contacted in case of emergencies. In the event parents or other persons named cannot be contacted, I authorize school officials to take whatever action deemed necessary to ensure the health and safety of my child. I will not hold the school district, or its employees, financially responsible for emergency care and/or transportation. FOR OFFICE USE ONLY ENTRY DATE: _______________LOCAL ID:______________UID:_________________ ______________________________________________ ELIG CODE:_________BUS #:___________TEACHER:__________________________ PARENT/GUARDIAN SIGNATURE DATE PREVIOUS SCHOOL/DISTRICT ATTENDED:___________________________________ THIS PAGE LEFT BLANK PLEASE CONTINUE CELINA ISD GENERAL INFORMATION SURVEY, PAGE 1 (FOR SCHOOL ENROLLMENT) NAME OF STUDENT: ____________________________________________ NAME AND ADDRESS OF LAST SCHOOL ATTENDED: NAME OF SCHOOL __________________________________________________________________________ MAILING ADDRESS __________________________________________________________________________ (STREET/PO BOX) CITY ST ZIP TELEPHONE NUMBERS __________________________________________________________________________ (SCHOOL NUMBER) (FAX NUMBER) CLASSIFICATION: NEW STUDENT? _____________________ RETURNING STUDENT? ___________________________ WHICH GRADE LEVEL? (PLEASE CHECK ONE) ____PK ____3rd ____5th ____7th ____9th ____K ____10th ____1st ____4th ____6th ____8th ____11th ____2nd ____12th Has your child ever attended a Celina ISD school before? ____Yes ____No If YES, name of school: ______________________________________Grade Level: ______School Year: ___________ ________________________________________________________________________________________________________________________ SIBLING INFORMATION: Please list brothers and sisters of enrolling student NAME AGE GRADE LEVEL SCHOOL NAME _________________________________________________________ ____________ _______________________________________ _________________________________________________________ ____________ ________________________________________ ________________________________________________________ _ ____________ ________________________________________ ________________________________________________________ _ ____________ ________________________________________ ________________________________________________________________________________________________________________________ PLEASE CONTINUE ON BACK. CELINA ISD GENERAL INFORMATION SURVEY, PAGE 2 (FOR SCHOOL ENROLLMENT) NAME OF STUDENT: ___________________________________________________ LIST BELOW THE PAST SCHOOLS ATTENDED FOR THE ENROLLING STUDENT, IF IN GRADES PK – 6TH: TOWN OR CITY/STATE NAME OF SCHOOL GRADE LEVEL SCHOOL YEAR ____________________________________________ _____________________________________ ___________ ________________ ___________________________________________ _____________________________________ ___________ ________________ ___________________________________________ ____________________________________ ___________ ________________ ___________________________________________ ____________________________________ ___________ ________________ ___________________________________________ ____________________________________ ___________ ________________ ___________________________________________ ____________________________________ ___________ ________________ ___________________________________________ ____________________________________ ___________ ________________ SERVICES - IS YOUR CHILD CURRENTLY RECEIVING ANY OF THE FOLLOWING SERVICES? Bilingual/ESL YES _____ NO _____ Special Education Program YES _____ NO _____ Please circle those that apply: A. Resource B. Speech Therapy C. Other _________________ 504 YES _____ NO _____ Dyslexia YES _____ NO _____ Gifted and Talented YES _____ NO _____ Migrant YES _____ NO _____ Social Services YES _____ NO _____ Do you have a 2085 Form? YES _____ NO _____ Free/Reduced Lunch Program YES _____ NO _____ Other Services? __________________________________________________________________________________________