FONTANA JT. 8 SCHOOL DISTRICT New Student Registration Form Today’s Date: Student Last Name:

Student First Name:

Street Address for bus:

Middle Initial: Date of Birth:

City/State/Zip: Home Phone: Mailing Address (if different):

Grade: Homeroom: Gender: Student Lives With:

Preschool-5K: My child is __ toilet trained, ___ not toilet trained, or ___ partially toilet trained. State/Federal Law requires the school district to report ethnic information – please answer questions below: 1. Is this student Hispanic or Latino (choose only one) ___ No, not Hispanic or Latino ___ Yes, Hispanic or Latino 2. Is this student: (Choose one or more. You must select at least one.) ___ American Indian or Alaska Native ___ Asian ___ White ___ Black or African American ___ Native Hawaiian or Other Pacific Islander _______________________________________________ Proof of Birth for Registration: ___ Birth Certificate City/State/County/Country where born:

Transportation: How far do you live from Fontana School? (Please check one) ____0 – 2 miles ___ 2 – 5 miles ____5 – 8 miles ___ 8 – 12 miles ______________________________________________ School Last Attended with Address/Phone Number

Mother or Legal Guardian: Address: City/State/Zip: Home Phone: Employer: Work Phone: Cell Phone: Email: Name of significant other in home: _________________________________________________ Work # __________________________________________ Cell # ___________________________________________

Father or Legal Guardian: Address: City/State/Zip: Home Phone: Employer: Work Phone: Cell Phone: Email: Name of significant other in home: _________________________________________________ Work # __________________________________________ Cell # ___________________________________________

_____________________________________________ Has your child been retained in any grade? Yes ___ No ___ Which grade? ______________ Does your child currently receive special education services? Yes ___ No ___ Is there anything special you would like the school to know about your child? _______________________ ____________________________________________ How can we help you and your child best adjust to our school? _________________________________

EMERGENCY CONTACTS (should be a LOCAL number): Please list name and relationship of person(s) who will pick up your child and assume temporary care if you cannot be reached. Name: ____________________________________________ ______ Relationship: ________________________________ Home Phone: ______________________Work Phone: _______________________Cell Phone: _______________________ Name: ____________________________________________ ______ Relationship: ________________________________ Home Phone: ______________________Work Phone: _______________________Cell Phone: _______________________ Name: ____________________________________________ ______ Relationship: ________________________________ Home Phone: ______________________Work Phone: _______________________Cell Phone: _______________________ In case of early school closing, or other school emergency, our school will use Campus Messenger to notify parents. Since the System makes all of the phone calls using the information in Infinite Campus, please make sure your information is kept up-to-date.

(Please fill out reverse side of form.)

Is this student a child of a military family?

Yes

No

Names and birthdates of other children in the family for our census: (Circle gender M or F) Name ________________________________ _Grade _______

Birthdate ____________________M _____ or F

Name ______________________________ ___Grade _______

Birthdate ____________________M _____ or F

Name ______________________________ ___Grade _______

Birthdate ____________________M _____or F

Medical Alert Information/Medication/Allergies (Will be shared with Fontana School Staff and Coaches) Parents are responsible for providing all daily and emergency medications prescribed by the students’ healthcare provider and keeping medications (and medication forms) up-to-date. Does your child have a severe food allergy? Yes ____ No ____If so, to what? _____________________________________ Severe bee sting allergy? Yes ____No ____ Epi-pen at school for either bee sting or food allergy? Yes ____No ____ Latex sensitive? Yes ____No ____Asthma? Yes ____No ____ Inhaler at school? Yes ____No ____ Does your child wear glasses or contacts? ____________________

Any other medical conditions we should know about?________________________________________________________ ___________________________________________________________________________________________________ Family Physician: __________________________________________ Phone: ____________________________________ Family Dentist: ____________________________________________ Phone: ____________________________________ Hospital: _________________________________________________Phone: ____________________________________ I hereby authorize school personnel to call a physician, dentist or emergency vehicle if an emergency exists. _________________________________________________________ Signature of Parent or Legal Guardian

__________________________ Date

It is the policy of Fontana Jt. 8 School District that no person may be denied employment, denied admission to school or be denied participation in, be denied the benefits of, or be discriminated against in any curricular, extracurricular, pupil services, recreation, or other program, on the basis of sex, race, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation or physical, mental, emotional, or learning disability.

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