Central Community School System :: Intent to Register

Intent to Register for 2010-2011 School Year

Complete this form if you intend to register your child in the Central Community School System for the school year 2010-2011. List only children NOT currently registered in the Central Community School System. A separate form should be completed for each child to be registered. ALL INFORMATION WILL BE KEPT CONFIDENTIAL.

**Please answer questions carefully. What Central school are you registering your child for the 2010-11 school year? Then we need the grade and school your child LAST attended. Before a student is placed in a grade level at a school, previous records must be reviewed.

Intent to Register

Parent(s) Name

Address

City

Zip

Phone #

Child's Name

Child's Birthdate

Child's Gender

What school are you planning to register your child this 2010-11 school year *

Grade attended in 2009-2010 school year *

Last School Attended *

Special Needs (what special services does your child receive, if any)

Please type the letters and numbers shown in the image.