School Registration Form ASLA 2022-2023

Lee County School District
Additional documents for registration

Bring this registration form and the following documentation to the school office or submit the registration form and documentation online.

• Original Certified Birth Certificate

• Original Social Security Card

• Current Immunization Form

• Current Proofs of Residence (ex. power, water or gas bill)

• Other
Upload all necessary documentation listed in the online form here.

Browse Files

Cancelof
Signature

Clear
Student Information
Last Name
First Name
M.I.
Birth Date

MonthDayYear
Date
Gender
Ethnicity
Email Address
example@example.com
Entry Year
Grade
Semester
Have you previously applied to or attended this school?

YesNo
If yes, what year?
Current Residence Information
Street Address
Street Address Line 2
City
State
Zip Code
Home Phone Number
Cell Phone Number
Primary Residence Information (if different from above)
Street Address
Street Address Line 2
City
State
Zip Code
Parent/Guardian Residence Information (if different from above)
Street Address
Street Address Line 2
City
State
Zip Code

Emergency Contact 1
Last Name
First Name
Primary Phone Number
Secondary Phone Number
Emergency Contact 2
Last Name
First Name
Primary Phone Number
Secondary Phone Number
Physician and Medical Information
Last Name
First Name
Primary Phone Number
Secondary Phone Number
Preferred Hospital
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Enrollment History
Previous School 1
School Name
City
State
Date Started

MonthDayYear
Date
Date Ended

MonthDayYear
Date
Previous School 2
School Name
City
State
Date Started

MonthDayYear
Date
Date Ended

MonthDayYear
Date
Previous School 3
School Name
City
State
Date Started

MonthDayYear
Date
Date Ended

MonthDayYear
Date
Notes
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.
Options for learning - please choose one. *Depending on which option is chosen it MUST be committed to for the entire semester.*

Virtual / OnlineOnsite / In Classroom
Do you have internet access in your home?

YesNo
Should be Empty: