Parent Email Enter your email if you would like to receive a copy of this submission via email.Student InformationName * Required First Middle Last Suffix Date of Birth * Required MM slash DD slash YYYY Address * Required Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code WVEIS# Name of Preschool * Required School * RequiredAlban ElementaryAlum Creek ElementaryAndrews Heights ElementaryAnne Bailey ElementaryBelle ElementaryBridgeview ElementaryCedar Grove ElementaryCentral ElementaryChamberlain ElementaryChandler AcademyChesapeake ElementaryClendenin ElementaryCross Lanes ElementaryDunbar Primary CenterEdgewood ElementaryElk Elementary CenterFlinn ElementaryHolz ElementaryKanawha City ElementaryKenna ElementaryLakewood ElementaryMalden ElementaryMary C. Snow West Side ElementaryMary Ingles ElementaryMidland Trail ElementaryMontrose ElementaryNitro ElementaryOverbrook ElementaryPiedmont Year Round EducationPinch ElementaryPoint Harmony ElementaryPratt ElementaryRichmond ElementaryRuffner ElementaryRuthlawn ElementarySharon Dawes ElementaryShoals ElementarySissonville ElementaryWeberwood ElementaryNames and Grades of Brothers and Sisters Parent/Guardian InformationCustodial Parent/GuardianName * Required First Last Suffix Relationship * Required Home Phone * RequiredCell PhoneAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Second Parent/GuardianName First Last Suffix Relationship Home PhoneCell PhoneAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Physician's Name * Required Phone NumberDentist's Name * Required Phone NumberPersons who will assume responsibility if parent cannot be contacted.Name * Required First Last Relationship to Student * Required Home Phone * RequiredCell PhoneWork PhoneName * Required First Last Relationship to Student * Required Home Phone * RequiredCell PhoneWork PhoneName First Last Relationship to Student Cell PhoneHome PhoneWork PhonePlease keep in mind that any person listed in the section above, or on the first page of this document, may be able to sign your child out of school after showing proper identification. If there are any custody issues or changes, you must provide the school with a copy of the most recent Court Orders and complete a new emergency card.Are there any custody issues concerning your child? * RequiredYesNoIf so, have you provided the school with the Court Orders?YesNoIn case of accident or serious illness, the school will contact the parent/guardian. If the school is unable to contact the parent or designated person, arrangements will be made for immediate treatment. Payment of fees will be assumed by the parent/guardian.Parent/Legal Guardian's SignatureDate * Required MM slash DD slash YYYY Parent/Legal Guardian's Signature * RequiredThe following information must be on file as required by the U.S. Office of Civil Rights.Is there a language other than English spoken in your home? * RequiredYesNoSpecify language Does your child communicate in a language other than English? * RequiredYesNoSpecify language? What language did your child learn first? * Required Specify languageWhat is the primary language spoken in the home, regardless of the language spoken by the student? * Required Ethnicity/Race of Student * Required DocumentsPlease use the 'Document Uploads' field to attach any electronic documents that you would like to submit. Ex. Birth Certificate, Proof of Residency, Allergy Information .. Documents must be in .PDF, .PNG, or .JPG format If you cannot provide virtual copies of your documents, please mail them to the appropriate school. Document Uploads Drop files here or Select files Accepted file types: pdf, png, jpg, jpeg, Max. file size: 64 MB, Max. files: 10.