Student Full/Legal Name:
Birthdate:
Student Address:
City:
State:
Zip Code:
Home Phone:
Current School:
Parents/Guradians 1 List parents/guardians living with student (i.e. mom & dad, mom & stepdad, etc.)
Relationship to Student:
Name 1:
Phone:
Workphone:
Email:
Name 2:
Phone:
Workphone:
Email:
Parents/Guardian 2 List other parent household, if applicable. (Parents/Guardians not living with student.)
Relationship to Student:
Name 1:
Phone:
Workphone:
Email:
Name 2:
Phone:
Workphone:
Email:
Emergency Contacts:
Contact 1 Name:
Phone Number:
Relationship to student:
Emergency Contact 2 Name:
Phone:
Relationship to student:
Emergency Contact 3 Name:
Phone:
Relationship to student:
Emergency Contact 4 Name:
Phone:
Relationship to student:
Additional Enrollment Questions
1. Is there anyone, by court order, who is not allowed to pick up your student? If so, please list.(School must be provided legal documents in order to enforce if a person listed is a parent.)
Does your student have or receive:
Is your student currently under expulsion/suspension from another school?
Is your student interested in enrolling in the EVSC's Virtual Academy (online school) or New Tech Institute (high school)? If so, please check which one.
Digital Access
Does your student have access to the Internet at home?
Does your student have access to a device at home?
If yes, how many devices do you available at home for your student? (smartphone, laptop, ipad, etc.)
By entering your name below, you confirm that the information shared above is true, correct and to the best of your knowledge.
Parent Signature: Date:
Security Measure