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Enrollment Form

Hastings Area Schools

Enrollment Form

Parent/Guardian must supply student's State Certified Birth Certificate, Immunization Record and Proof of Residency upon enrollment.

This will require you to come into the Administration Office at 232 W. Grand St., Hastings, MI 49058 after completing this form.

STUDENT INFORMATION

Student's Legal First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Grade*

Answer Required

Street Address (Home)*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

County*

Answer Required

Birth Date*

Answer Required

Gender*

Answer Required

Email (receives robo emails)*

Answer Required

Phone Number for Robo Calls (no school, delay, etc.)*

Number Required

Student Cellphone (if applicable)

Number Required

Who does the student reside with?*

Answer Required

Custody Arrangements (if applicable)

Answer Required

If yes, who is not to have contact?

Answer Required

Mailing Address (if different from home address) or Second Mailing Address to non-custodial parent (if applicable):

Name of person associated with mailing address:

Answer Required

Relationship:

Answer Required

Street:

Answer Required

City

Answer Required

State

Answer Required

Zip:

Answer Required

If non-resident, what district?

Answer Required

EDUCATIONAL INFORMATION

Previous School District*

Answer Required

Does the student currently receive any kind of Special Education Services (i.e. IEP, Speech, Physical or Occupational Therapy, 504)?*

Answer Required

If a student receives Special Education Services, they must also enroll at the Barry Intermediate School District, 555 W. Woodlawn Ave., Hastings, MI 49058. This must be done before the student can be enrolled in the school.

PARENT/GUARDIAN AND EMERGENCY INFORMATION

Parent 1

Relationship to student

Answer Required

First Name

Answer Required

Last Name

Answer Required

Place of Employment

Answer Required

Mobile Phone

Number Required

Home Phone

Number Required

Work Phone

Number Required

Name of Legal Step-Parent (if applicable)

Answer Required

Phone of Step-Parent

Number Required

Parent 2

Relationship to student

Answer Required

First Name

Answer Required

Last Name

Answer Required

Place of Employment

Answer Required

Mobile Phone

Number Required

Home Phone

Number Required

Work Phone

Number Required

Name of Legal Step-Parent (if applicable)

Answer Required

Phone of Step-Parent

Number Required

List people (other than above parents) the school may contact in case of illness/and emergency.

They will also be allowed to pick up/transport your student.

Full Name

Answer Required

Relationship to student

Answer Required

Phone

Number Required

Full Name

Answer Required

Relationship to student

Answer Required

Phone

Number Required

Full Name

Answer Required

Relationship to student

Answer Required

Phone

Number Required

RACE/ETHNICITY

What is the student's race? (Please check all that apply)*

Answer Required

American Indian or Alaska Native

Asian

Black or African American

Hispanic

Native Hawaiian or Other Pacific Islander

White

Primary Race*

Answer Required

Secondary Race (if applicable)

Answer Required

If no, what is the language?

Answer Required

What is the primary language in the home?*

Answer Required

MEDICAL INFORMATION

List any health conditions or allergies*

Answer Required

What medication is the student currently taking?*

Answer Required

Preferred Medical Facility/Hospital*

Answer Required

Family Doctor

Name*

Answer Required

Phone*

Number Required

If student requires medication to be administered (including over-the-counter), please complete an "Authorization for Medication or Treatment" form in the office.

LIVING ARRANGEMENT

The student's current living arrangement:*

Answer Required

OTHER SCHOOL AGE CHILDREN IN THE FAMILY

Full Name

Answer Required

Date of Birth

Answer Required

Grade

Answer Required

School

Answer Required

Full Name

Answer Required

Date of Birth

Answer Required

Grade

Answer Required

School

Answer Required

Full Name

Answer Required

Date of Birth

Answer Required

Grade

Answer Required

School

Answer Required

Full Name

Answer Required

Date of Birth

Answer Required

Grade

Answer Required

School

Answer Required

Full Name

Answer Required

Date of Birth

Answer Required

Grade

Answer Required

School

Answer Required

RELEASES

I give permission for my child to attend school-sponsored programs during the school year when special programs are held in one school building or facility within the Hastings Area School System. I also give my permission for my student to be transported by bus to that site. Parents are notified of these events by the teacher or in a school newsletter.*

Answer Required

Each year the District will provide public notice to students and their parents of its intent to make available, upon request, certain information known as "directory information". The School Board designates as student "directory information", a student's name; address; telephone number; date of birth; major field of study; participation in officially recognized activities and sports; dates of attendance; date of graduation; awards received; or any other information which would not generally be considered harmful or an invasion of privacy, if disclosed. I give permission to include my child in this directory.*

Answer Required

Under penalty of perjury, I verify that all information given is true and correct to the best of my knowledge.

Electronic Signature*

Answer Required

This enrollment form does not complete your student's registration! You need to come into the Administration Office for K-12 to provide the official birth certificate, immunization records, proof of residency, hearing and vision screening (YK/K only) and sign forms.

Administration Office: 232 W. Grand St., Hastings, MI 49058

Any questions, call 269-948-4400.

Confirmation Email

Email Required