Wakefield Public Schools Registration Form

School *

Enrollment Date *

Child's First Name *

Child's Middle Name: * 🛈

Child's Last Name: *

Address *

City *

State *

Postal Code *

Gender *

Date of Birth *

City/Town of Birth *

Home Phone *

Emergency Phone *

Year of Graduation

Grade Level *

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Guardian 1 *

Guardian 1 Street Address *

City *

State *

Zip Code *

Guardian 1 Phone Number *

Phone 1 Type: *

Guardian 1 Phone Number

Phone 2 Type:

Guardian 1 Email Address: *

Guardian 1 Occupation *

Guardian 1 Birthplace *

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Guardian 2

Guardian 2 Street Address

City

State

Zip Code

Guardian 2 Phone Number

Phone 2 Type:

Guardian 2 Phone Number

Phone 2 Type:

Guardian 2 Email Address:

Guardian 2 Occupation

Guardian 2 Birthplace

Guardian 3 Name

Guardian 3 Street Address

City

State

Zip Code

Guardian 3 Phone Number

Phone 3 Type:

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Home Language *

Primary Language of Student *

Ethnic Background (Check all that apply) *

American Indian or Alaskan Native: A person having origins in any of the original people of North America, and who maintains cultural identification through tribal affiliation or community attachment

Asian or Pacific Islander: A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Samoa

Black: A person having origins in any of the black racial groups of Africa

White: A person having origins in any of the original people of Europe, North Africa, or the Middle East

Hispanic: A person of Mexican, Puerto Rican, Cuban, Central or South America or other Spanish culture of origin, regardless of race.

Low Income Status (Select One) *

The student is eligible for free or reduced lunch; or receives Transition Aid to Families benefits; or is eligible for food stamps.

Not Applicable

Perkins Low Income Status (Select One) *

The family has an annual income below the federal poverty guidelines; or the family receives Transitional Aid to Families; or the student is a state ward (foster child) or is in an institution for the neglected or delinquent; or the student is eligible for free/reduced price lunch.

Not Applicable

Migrant Status (Select One) *

An indication of whether an individual or a parent/guardian accompanying an individual maintains primary employment in one or more agricultural or fishing activities on a seasonal or other temporary basis and establishes a temporary residence for the purpose of such employment.

Not Applicable

Immigrant Status (Select One) *

An indication of whether a student is eligible for the Emergency Immigrant Education Program is, the student must not have been born in any State (any of the 50 states, the Commonwealth of Puerto Rico, the district of Columbia, Guam, American Samoa, the Virgin Islands, the Northern Mariana Islands, or the territory of the Pacific Islands) and not having completed 3 full academic years of school in any state.

Not Applicable

Country of Origin *

By typing your name in the below box, you are agreeing that all the information provided is accurate and true. *