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 - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Address * Required Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code WVEIS#Name of Preschool * RequiredSchool * RequiredAlban ElementaryAlum Creek ElementaryAndrews Heights ElementaryAnne Bailey ElementaryBelle ElementaryBridgeview ElementaryCedar Grove ElementaryCentral ElementaryChamberlain ElementaryChandler AcademyChesapeake ElementaryClendenin ElementaryCross Lanes ElementaryDunbar Primary CenterEdgewood ElementaryElk Elementary CenterFlinn ElementaryGeorge C. Weimer ElementaryGrandview ElementaryHolz ElementaryKanawha City ElementaryKenna ElementaryLakewood ElementaryMalden ElementaryMarmet 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 SistersParent/Guardian InformationCustodial Parent/GuardianName * Required First Last Suffix Relationship * RequiredHome Phone * RequiredCell PhoneAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Second Parent/GuardianName First Last Suffix RelationshipHome PhoneCell PhoneAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Physician's Name * RequiredPhone NumberDentist's Name * RequiredPhone NumberPersons who will assume responsibility if parent cannot be contacted.Name * Required First Last Relationship to Student * RequiredHome Phone * RequiredCell PhoneWork PhoneName * Required First Last Relationship to Student * RequiredHome Phone * RequiredCell PhoneWork PhoneName First Last Relationship to StudentCell 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 - must be mm/dd/yyyy format * Required Date Format: 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.Does your child speak a native language other than English? * RequiredYesNoIf yes, which language?Does either parent speak a native language other than English? * RequiredYesNoIf yes, which language?What language does the student speak most of the time? * RequiredWhat is the language that the student first speak and understand? * RequiredWhat is the primary language spoken in the home, regardless of the language spoken by the student? * RequiredEthnicity/Race of Student * RequiredDocumentsPlease 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 Accepted file types: pdf, png, jpg, jpeg. This iframe contains the logic required to handle Ajax powered Gravity Forms.