School:

Term:		 Christ Lutheran School

New Student
     
CLS Demographics
 
*CLS Demographics
 
                 
This form may be filled out online and then printed or printed and then filled out.
Student Information
Name (Last, First Middle): Room HR Teacher
 
Preferred Name:
Parent Listing for Phone book

Street Address:



County

Student Mailing Address:


Home Phone: Student Cell Phone:
Age: DOB: Baptism
Birthplace: Gender: Congregation
Grade Level: Graduation Year: Oldest K-8
Ethnicity:
Home Language:
 Youngest K-8
Aggregate days of membership (YTD):
For Transfer Students Only
Previous School Attended: School Address:
Phone: City, State Zip:
Family Information
Parents are: Resides with:

Father (last, first): Mother (last, first):
Father's Home Phone: Mother's Home Phone:
Father's Cell Phone: Mother's Cell Phone:
Father's Address Mother's Address
Father's Employer: Mother's Employer:
Father's Work Phone: Mother's Work Phone:
Father's Email: Mother's Email:
Stepfather (last, first): Stepmother (last, first):
Stepfather's Home Phone: Stepmother's Home Phone:
Stepfather's Cell Phone: Stepmother's Cell Phone:
Stepfather's Address Stepmother's Address
Stepfather's Employer: Stepmother's Employer:
Stepfather's Work Phone: Stepmother's Work Phone:
Stepfather's Email: Stepmother's Email:
       
PowerSchool Contact Email (more than one may be entered, seperated by commas):
Additional Mailing Name (first last): Additional Mailing Address:
,

Emergency Information (In the event a parent cannot be reached, please list additional contacts.)
Emergency Contact #1: Relationship:
Emergency Phone: Phone Type:
Emergency Contact #2: Relationship:
Emergency Phone: Phone Type:
Emergency Contact #3: Relationship:
Emergency Phone: Phone Type:
Doctor: Doctor Phone:
Dentist: Dentist Phone:
Medical Conditions:
State Report Information
State ID Number: . Student SNN: Lunch Status:
ELL Student: Migrant Student: Student has 504:
Student has an Individual Education Plan (IEP): If yes, select program:
Release Information
May we share medical information with school staff? Another question could go here
May we use information for the web? (Includes things such as musical, nursing home, classroom activities, awards etc.)