Registration Form

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Contact Information

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Cell Home Work This is a required field.

Cell Home Work

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School Information

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If you do not know your District of Residence, please click here and type your home address in the "School Search" box on the top of the page. The search results will list public schools in your district, with the district number listed last. Please list the elementary school district.

Religious Background


Catholic Christian Other This is a required field.

Family Information


Married Separated Divorced Deceased Mother Deceased Father Other This is a required field.

Both parents Mother/Stepfather Father/Stepmother Mother only Father only Joint custody Other This is a required field.

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Mailing Address

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No Yes required

Parent/Guardian 1

Mother Father Legal Guardian Stepmother Stepfather Other This is a required field.

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Cell Home Work This is a required field.

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Workplace Information

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Parent/Guardian 2

Mother Father Legal Guardian Stepmother Stepfather Other

Workplace Information

Grandparent

Grandmother Grandfather

Emergency Contact Information
In the event of an emergency, all efforts will be made to reach the parent or guardian directly. In case this is not possible, please provide an emergency contact person(s).

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Cell Home Work This is a required field.

Medical Information

Please provide the following information for use in the event of a medical emergency.

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Race and Ethnicity Information

The New York State Department has requested that all schools collect race and ethnicity statistics for reporting of State Regents Exam beginning in June of 2011. Please review and respond to all questions.

No, not Hispanic or Latino Yes, Hispanic or Latino This is a required field.

The above part of the question is about ethnicity, not race. No matter what you selected above, please continue to answer the following, if applicable, by marking one or more boxes to indicate what you consider your race.


American Indian or Alaskan Native Asian Black or African American (not Hispanic) Hispanic or Latino Native Hawaiian or other Pacific Islander White (not Hispanic) Multiracial (not Hispanic) This is a required field.

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