Enrollment Updates
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*
= required field
*
Student's Last Name
*
Student's First Name
*
Gender
male
female
*
Birthdate
*
Select School Year applying for
(2010 - 2011 only)
Select Year Applying For
2010-2011
*
Select Grade Level for year applying for
(select)
kindergarten
first grade
second grade
third grade
fourth grade
fifth grade
sixth grade
seventh grade
eighth grade
Note: Students admitted to Kindergarten must be five years of age by October 1st of the school year applying for. 1st Graders must be 6 years old by October 1st.
*
Present School Name & School District
Present School Address
*
Parent/Guardian Last Name
*
Parent/Guardian First Name
*
Current School District of Residence
*
Present Address
*
City
*
State
(select)
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CT
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DE
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ID
IL
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MD
ME
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MS
MO
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NH
NJ
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NY
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ND
OH
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OR
PA
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TN
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VT
VA
WA
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WI
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*
Zip
*
Home Phone
Example: (555-123-1234)
*
Work or Cell Phone
Best Time to Call
Email Address
Does this child have a sibling CURRENTLY attending BLRA?
Yes
No
If yes, siblings name(s) and grade
Is your child currently receiving Special Education Services?
Yes
No
If YES, does your child currently have an IEP or 504 plan?
Yes
No
Not Applicable
What is her/her disability?
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