Mannsdale Elementary School
Registration Information
Student Name_________________________________________________________________________________
Last First Middle
Preferred Name:______________________________ Social Security Number______-______-______
Race(circle): B W A H Native American Other__________ Gender (circle) M F
Date of Birth: ________________________________ Grade: _________________________________
Street Address_______________________________________City_________________Zip___________________
Subdivision___________________________________ Own/Lease:__________ Lease expires:____________
Student lives with (check all that apply): ____ Mother ____Father ____Stepfather ____Stepmother ____Other
Mother/Guardian Name_________________________________________________________________________
Address if different from child ____________________________________________________________________
Home Phone ____________________ Work Phone____________________ Cell Phone___________________
Place of Employment ________________________________________ Occupation________________________
E-Mail Address_________________________________________________________________________________
Father/Guardian Name__________________________________________________________________________
Address if different from child ____________________________________________________________________
Home Phone ____________________ Work Phone____________________ Cell Phone___________________
Place of Employment ________________________________________ Occupation________________________
E-Mail Address_________________________________________________________________________________
Siblings, grade, DOB, and school: ___________________________ _____ __/__/__ _____________________
___________________________ _____ __/__/__ ______________________
___________________________ _____ __/__/__ ______________________
Pre-School: ____Yes ____No Name of school attended: _________________________________________
Special Services (circle): Gifted SPED – IEP Speech – IEP ELL
Emergency numbers and individuals authorized to check out:
1. __________________________________Relationship _________________ Phone #_________________
2. __________________________________Relationship _________________ Phone # ________________
3. __________________________________Relationship _________________ Phone # ________________
*****DO NOT RELEASE CHILD TO:________ (Please provide legal documentation)______________________
_____ Yes, my child’s name, address & phone number may appear in the school directory.
_____ No, my child’s name, address and phone number may not appear in the school directory.
