Re-Enrollment

2009/2010 School Year

Student ____________________________ Entering Grade_____________

Parent(s) or Guardian

_____________________________________________________________

_____________________________________________________________

Address

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Home Phone #____________________

Work # _________________________ ___________________________

Cell # __________________________ __________________________

E-Mail Address________________________________________________

In Case of Emergency contact the following if parent/guardian is unavailable:

Name__________________________ Phone #______________________

Name__________________________ Phone #______________________

Person(s) other than parent/guardian authorized to pick up child(ren):

Name__________________________ Name________________________

Name__________________________ Name________________________