Editing previous response:

Please fix the highlighted areas below before submitting.

Student Registration Form

Student Information**

**Required documentation for enrollment of prek-12 McKinney-Vento (homeles), foster care and military students is an exception.

School in which the student will be enrolling*

Answer required for "School in which the student will be enrolling"

Lillian M. Jacobs School

Hull High School

Grade Entering*

Answer required for "Grade Entering"

Registration Date*

Answer required for "Registration Date"

Student's Legal First Name*

Answer required for "Student's Legal First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Street Address*

Answer required for "Street Address"

Town/State/Zip*

Answer required for "Town/State/Zip"

Mailing Address (if different)

Answer required for "Mailing Address (if different)"

Primary Family Email*

Answer required for "Primary Family Email"

Primary Phone*

Number Required

Secondary Phone

Number Required

Alternate Phone/Email

Answer required for "Alternate Phone/Email"

Gender*

Answer required for "Gender"

Date of Birth*

Answer required for "Date of Birth"

City/Town & State of Birth*

Answer required for "City/Town & State of Birth"

Race (Please check all that apply)*

Answer required for "Race (Please check all that apply)"

American Indian/Alaska Native

Native Hawaiian/other Pacific Islander

Asian

Black/African American

White/Caucasian

Ethnicity*

Answer required for "Ethnicity"

Hispanic/Latino

Not Hispanic/Latino

Native Language of Student*

Answer required for "Native Language of Student"

Parent/Legal Guardian Information

Parent/Guardian 1

First Name*

Answer required for "First Name"

Middle Initial

Answer required for "Middle Initial"

Last Name*

Answer required for "Last Name"

Address (if different from student's

Answer required for "Address (if different from student's"

Email*

Answer required for "Email"

Primary Phone*

Number Required

Secondary Phone

Number Required

Work Phone

Number Required

Relationship to Student

Answer required for "Relationship to Student"

Can Pick Up Child

Answer required for "Can Pick Up Child"

Yes

Has Legal Custody

Answer required for "Has Legal Custody"

Yes

Is Parent/Guardian 1 an Emergency Contact?

Answer required for "Is Parent/Guardian 1 an Emergency Contact?"

Yes

Parent/Guardian 2

First Name*

Answer required for "First Name"

Middle Initial

Answer required for "Middle Initial"

Last Name*

Answer required for "Last Name"

Address (if different from student's)

Answer required for "Address (if different from student's)"

Email*

Answer required for "Email"

Primary Phone*

Number Required

Secondary Phone

Number Required

Work Phone

Number Required

Relationship to Student

Answer required for "Relationship to Student"

Can Pick Up Child

Answer required for "Can Pick Up Child"

Yes

Has Legal Custody

Answer required for "Has Legal Custody"

Yes

Is Parent/Guardian 2 an Emergency Contact?

Answer required for "Is Parent/Guardian 2 an Emergency Contact?"

Yes

Other/Guardian 3

First Name*

Answer required for "First Name"

Middle Initial

Answer required for "Middle Initial"

Last Name*

Answer required for "Last Name"

Address (if different from student's)

Answer required for "Address (if different from student's)"

Email*

Answer required for "Email"

Primary Phone*

Number Required

Secondary Phone

Number Required

Work Phone

Number Required

Relationship to Student*

Answer required for "Relationship to Student"

Can Pick Up Child

Answer required for "Can Pick Up Child"

Yes

Has Legal Custody

Answer required for "Has Legal Custody"

Yes

Is Other/Guardian 3 an Emergency Contact?

Answer required for "Is Other/Guardian 3 an Emergency Contact?"

Yes

Child resides with? (please check one)

Answer required for "Child resides with? (please check one)"

Both Parents

Parent 1

Parent 2

Guardian

Other:

If OTHER, please explain

Answer required for "If OTHER, please explain"

Are there any legal custody issues?

Answer required for "Are there any legal custody issues?"

Yes

If yes, please provide documentation to school principal.

The school cannot deny a parent's right to access a student and/or student information without proper legal documentation on file in the main office. It is the responsibility of the custodial parent/guardian to provide supporting documentation (e.g., court orders) to limit another parent's access to the student and/or student information.

Sibling Information (Please fill out the information for each sibling)

Sibling 1 - Name, Age, Gender, Grade

Answer required for "Sibling 1 - Name, Age, Gender, Grade"

Sibling 2 - Name, Age, Gender, Grade

Answer required for "Sibling 2 - Name, Age, Gender, Grade"

Sibling 3 - Name, Age, Gender, Grade

Answer required for "Sibling 3 - Name, Age, Gender, Grade"

Sibling 4 - Name, Age, Gender, Grade

Answer required for "Sibling 4 - Name, Age, Gender, Grade"

Sibling 5 - Name, Age, Gender, Grade

Answer required for "Sibling 5 - Name, Age, Gender, Grade"

Sibling 6 - Name, Age, Gender, Grade

Answer required for "Sibling 6 - Name, Age, Gender, Grade"

Parent/Guardian Military Status - option to self-identify military status

As part of the interstate Commission on Educational Opportunity for Military Children, Massachusetts school districts may collect military family status information. Please check the appropriate boxes for any parent or guardian of the child being registered.

Answer required for "As part of the interstate Commission on Educational Opportunity for Military Children, Massachusetts school districts may collect military family status information. Please check the appropriate boxes for any parent or guardian of the child being registered. "

An active duty member of the uniformed services, including the National Guard and Reserve on active duty orders.

A member or veteran of the uniformed services injured and medically discharged, or retired within on year.

A member of the uniformed services who died on active duty or as a result of injuries sustained on active duty

If you checked died on active duty or as a result of injuries sustained on active duty, please provide one of the following: Date of Discharge, Retirement, Death or Active Deployment.

Answer required for "If you checked died on active duty or as a result of injuries sustained on active duty, please provide one of the following: Date of Discharge, Retirement, Death or Active Deployment."

Local Emergency Contacts (if parent(s)/guardian(s) can't be contacted please list other contacts that can dismiss your child in case of emergency)

Contact 1 First & Last Name

Answer required for "Contact 1 First & Last Name"

Address

Answer required for "Address"

Primary Phone

Number Required

Secondary Phone

Number Required

Relationship to Student

Answer required for "Relationship to Student"

Contact 2 First & Last Name

Answer required for "Contact 2 First & Last Name"

Address

Answer required for "Address"

Primary Phone

Number Required

Secondary Phone

Number Required

Relationship to Student

Answer required for "Relationship to Student"

Contact 3 First & Last Name

Answer required for "Contact 3 First & Last Name"

Address

Answer required for "Address"

Primary Phone

Number Required

Secondary Phone

Number Required

Relationship to Student

Answer required for "Relationship to Student"

Previous School Information Please provide all available information.

Name of Last School Attended

Answer required for "Name of Last School Attended"

Full Address

Answer required for "Full Address"

Phone

Number Required

Fax

Number Required

Have records been requested?

Answer required for "Have records been requested?"

Yes

Special Services Information

Does your child receive any of the following services? Please check all that apply to student.

Answer required for "Does your child receive any of the following services? Please check all that apply to student."

ELL (English Language Learner)

Reading Support

Physical Therapy

Counseling

Speech/Language

Occupational Therapy

Does your child have an educational plan in place? Please check all that apply to student.

Answer required for "Does your child have an educational plan in place? Please check all that apply to student."

Has an Individual Educational Program (IEP for special education)

Has a Section 504 Accommodation Plan

Limited English Proficiency (LEP) Students

Has the student attended schools in the United States for less than 12 months?

Answer required for "Has the student attended schools in the United States for less than 12 months?"

Yes

Not Applicable

If the student was not born in the United States, has the student completed three (3) full academic years of school in any state?

Answer required for "If the student was not born in the United States, has the student completed three (3) full academic years of school in any state?"

Yes

Not Applicable

Medical Information

Does your child have any special health needs?

Answer required for "Does your child have any special health needs?"

Yes

If yes, please briefly explain.

Answer required for "If yes, please briefly explain."

Physician's Name

Answer required for "Physician's Name"

Physician's Phone

Number Required

Dentist's Name

Answer required for "Dentist's Name"

Dentist's Phone

Number Required

Parent/Guardian Signature

In case of accident or serious illness, and if school personnel are unable to reach me, I hereby authorize school personnel to make any arrangements that are deemed necessary.

I, the undersigned, am the parent or legal guardian of the child being registered. This child resides with me, and my place of residence is within the boundries of the Hull Public School District and the attendance area for this school. By my sugnature below, I am affirming that all information provided is accurate and truthful.

Signature*

Signature Required

Name: Date:

Sign this form

By pressing “Sign Form,” you are agreeing to signing this form electronically.

Signature *

Type to sign

Draw your signature

Full Name *

Date:

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"

Submitting form...

Protected by reCAPTCHA - Privacy - Terms

Please verify you are not a robot:

Please fix errors above