St. Louis Unified SDA School Registration 2022-2023

Please complete the School Registration form for the 2021-2022 school year.

Parent/Guardian Information

Name

*

Parent/ Guardian Email

*

This address will receive a confirmation email

Parent/ Guardian Phone

*

Marital Status

*

Please select one option.

Married Single Divorced Widow/Widower

If there is a special child custody agreement upload all legal documents here

Upload (8MB)

Additional Parent/Guardian Information

Parent/Guardian Name

Parent/Guardian Email

*

Parent/ Guardian Phone

Marital Status

*

Please select one option.

Married Single Divorced Widow/Widower

Emergency Contact (other than parent)

Emergency Contact Name

*

Emergency Contact Relationship

*

Emergency Contact Phone Number

*

Student Information

Date of Application

*

Student Name

*

Student Gender

*

Please select one option.

Male Female

Student Grade Level for the 2020-2021 school year

*

Please select one option.

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

Student Date Of Birth

*

Student Social Security Number

*

New students upload copy of Birth Certificate here

Upload (8MB)

Upload copy of up to date immunization records here

Upload (8MB)

Student Place of Birth

*

Student Address

*

Student Phone Number (leave blank if student does not have a phone)

Student Email (leave blank if student does not have an email)

Student Race Ethnicity

*

Please select one option.

American Indian Asian Black/African American/African/Caribbean etc. Pacific Islander White

Student Baptized

*

Please select one option.

Yes No

Student's Church Membership location

Description

Please complete the School Registration form for the 2021-2022 school year.

Please Fix the Following

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