Riverton U.S.D. 404 School District Enrollment Form Student Information
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- Horace Lambert
- 7 years ago
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1 Student 1: Legal Nickname: Gender: Student 2: Legal Nickname: Gender:
2 Student 3: Legal Nickname: Gender: Birthdate: Grade: Social Security: Student 4: Legal Nickname: Gender:
3 Student 5: Legal Nickname: Gender: Student 6: Legal Nickname: Gender:
4 Household Information School Year Date Student(s) Household Information: Residence Address: Mailing Address (if different than residence): Telephone number for Primary Residence: Telephone number for SchoolReach messages: Transportation mileage to school: Parent/Guardian 1: Parent/Guardian 2: Parent(s)/Guardian(s) at Second Residence: Do you want an additional mailing to go to this address? yes no Residence Address: Mailing Address (if different than residence): Telephone number for Second Residence: Telephone number for SchoolReach messages: Parent/Guardian 1: Parent/Guardian 2:
5 Contact Information Name of household: Emergency Information: Emergency Contacts are those people to whom we may release this student(s) in the event of an illness or injury if the Parent/Guardian can not be reached. DO NOT put the names of any previously listed Parent/Guardians in the following spaces. Emergency Contact #1: Only for (student) who s in (grade) Emergency Contact #2: Only for (student) who s in (grade) Emergency Contact #3: Only for (student) who s in (grade)
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