NEW CASTLE AREA SCHOOL DISTRICT
REGISTRATION FORM
NEW CASTLE SENIOR HIGH (9-12)
NEW CASTLE JUNIOR HIGH (7-8)
GEORGE WASHINGTON INTERMEDIATE (3-6)
LOCKLEY EARLY LEARNING CENTER (K-2)
CROTON PRE-K
Date Entered:__________________
(Last)
Place of Birth:
Date of Birth
Male Female
Grade Currently Enrolled:________
American
Indian
Asian Black
Native
Hawaiian
White Hispanic
Multi
Racial
Living with:
Mother Father Both Guardian Foster Other:
Father's Name:
(Last)
Employer: Ph:
(First)
Mother's Name:
(Last)
Employer: Ph:
(First)
Step-Father's
Name:
(Last)
Employer: Ph:
(First)
Step-Mother's
Name:
(Last)
Employer: Ph:
(First)
Present Address:
(Street) (City) (State) (Zip) (Home Phone) (Cell Phone) (Alt. Phone)
(Last)
Person child is living with (if other than parents):
(First)
In the event that the child is not living with
parents, a copy of any legal proceedings
must be attached to the enrollment form.
(Please list any other children living in the household age birth to 18)
Previous NCASD School Information
School/Program
(From)
Dates Attended:
(To)
School/Program
(From)
Dates Attended:
(To)
School/Program
(From)
Dates Attended:
(To)
Dates Attended:
(To)(From)
School/Program
Previous Non-NCASD School Information
City, State
Phone Fax
(To)(From)
Dates Attended:
FaxPhone
City, State
School/Program
(To)(From)
Dates Attended:
FaxPhone
City, State
School/Program
Homeroom Teacher:____________
ADMISSION APPROVED BY:_____________________________________________
Homeroom Number:____________
PA SECURE ID: _____________________
NCASD STUDENT ID:_________________
GR 9 ENTRY DATE:___________________
Does the child have an: IEP, GIEP, 504, ESL
For District Personnel Only
Verification of Residency:
___ Copy of dated rent recipt, if applicable.
___Copy of current utility bill listing date and address.
___Copy of current paid tax receipt.
___Other, Please identify___________________
Name:
(First) (Middle) (Suffix)
(State)(City)
Revised 11/02/2015
