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Registration of New Student (Grades 1-12)

Please complete the form below. Required fields marked with an asterisk *

STUDENT INFORMATION

Gender*
Answer Required
Country of Birth*
Answer Required

Residence Address

State*
Answer Required

Mailing Address (if different than Residence Address)

State
Answer Required
Is a language other than English spoken at home?*
Answer Required
Does your child speak a language other than English at home?*
Answer Required
Please answer yes or no:*
Answer Required
Yes
No
Is your current residence a temporary living arrangement?
Is your living arrangement due to the loss of housing or economic hardship?
Is your current residence inadequate for meeting physical and psychological needs?
Is parent in active military? *
Answer Required
Is parent in Reserves?*
Answer Required

PRIMARY HOUSEHOLD INFORMATION

The student lives with:*
Answer Required

Name of Parent/Guardian Student Lives with:

SECONDARY HOUSEHOLD INFORMATION

(Parent who lives in different household)

EMERGENCY INFORMATION

List two local persons (other than yourself) usually available during the school day who have agreed to care for and provide transportation for your student if he/she becomes ill or injured and you cannot be reached. We attempt to contact parents first.

HEALTH INFORMATION

EDUCATION AND PREVIOUS SCHOOL INFORMATION

Answer Yes or No:*
Answer Required
Yes
No
Student was assessed for special education services at his/her previous school
Student was served by an Individual Education Program (IEP) in the special education program at his/her previous school
Student received accommodations from a 504 plan at his/her previous school
Student left the previous school under disciplinary action, pending disciplinary action or in anticipation of disciplinary action.
Student has a history of violent behavior
Student has unpaid fines or fees at previous school*
Answer Required
Student has completed official checkout at previous school.*
Answer Required
Has student previously attended Crescent School?*
Answer Required

ATTESTATION

All of the information herein provided is true and accurate to the best of my knowledge.*
Answer Required
Confirmation Email