F. PARENT/GUARDIAN SIGNATURE
E. TRANSPORTATION INFORMATION
D. SCHOLASTIC INFORMATION
C. SIBLINGS
Sibling Name (First, Last) Date of Birth Age Grade School
Sibling Name (First, Last) Date of Birth Age Grade School
Sibling Name (First, Last) Date of Birth Age Grade School
Previous School: CCSD School Home Schooled Private School Private Preschool Program Other Public School Other Unknown
Previous School Name: City, State:
Has the student repeated a grade? Yes No
If yes, Grade(s) repeated
Has the student ever been expelled? Yes No
If yes, Grade(s) expelled
Did the student attend Kindergarten? Yes No
Does the student have any of the following designations:
(Check all that apply.)
504 Plan Gifted/Talented ESOL Migrant Student Transfer
Does the student have an Individualized Education Program (IEP)? Yes No
(If yes, specify the instructional setting.)
General Education Separate Class
Separate School Other:
Is transportation listed as a related service in the student’s IEP? Yes No
If the student has an IEP, please specify the area of disability:
(Check all that apply.)
Autism
Deaf-Blindness
Deafness
Developmental Delay
Emotional Disturbance
Hearing Impairment
Intellectual Disability
Multiple Disabilities
Orthopedic Impairment
Other Health Impairment
Specific Learning Disability
Speech or Language Impairment
Traumatic Brain Injury
Visual Impairment
Other (please specify)
How will the student get to school in the morning? AM Bus Only AM & PM Bus POV (Car Rider) Daycare Provides PM Bus Only Walker Bicycle
How will the student get home in the afternoon? AM Bus Only AM & PM Bus POV (Car Rider) Daycare Provides PM Bus Only Walker Bicycle
BY SIGNING THIS FORM, I AM CERTIFYING THAT ALL WRITTEN INFORMATION ON THIS FORM IS ACCURATE AND COMPLETE.
Signature of Parent/Guardian Date
CHARLESTON COUNTY SCHOOL DISTRICT REGISTRATION FORM
Birth Certificate Yes No SC Immunization Record Yes No Legal Guardianship/Custody Papers Yes No Out of Zone Yes No
Nonresident Yes No Chas Co property ownership Yes No Moving into Chas County Yes No Tuition Required Yes No
P/G: Picture ID Yes No Residency Affidavit Yes No Residency Verification Yes No Mail Verification Yes No
Other Head/Household: Notarized Statement Yes No Residency Verification Yes No Mail Verification Yes No
REVIEWED WITH P/G:
Home Language Survey Yes No
Scholastic Information Yes No
Records Requested: Records Received:
Cumulative File Reviewed: Teacher Assigned:
Enrollment Date: Bus Number:
NOTIFIED:
SPED Teacher 504 Coordinator
G/T Teacher ESOL Fed Programs
Student’s Legal Last Name and Suffix Student's Legal First Name Student's Legal Middle Name Student's Preferred Name
Parent/Guardian #2 Legal Name (First, Middle, Last & Suffix) Relationship to Student
Home Phone Cell Phone Day Phone Lives with student
Area Code
_______-_________________
Area Code
_______-________________
Area Code
_______-_________________ Yes No
Home Address, if different from student's Apt # City State Zip Code
Parent/Guardian #2 Employer Work Address (Street, City, State, Zip Code)
Is this Parent/Guardian employed by CCSD? Does this Parent/Guardian have custody of this student?
Yes No
(If yes, provide the following.)
Yes No
CCSD Employee No. Work Location Does this Parent/Guardian receive mailings? Yes No
Student Information/02-22-19