West Islip Registration Packet

West Islip Public Schools
The Michael and Christine Freyer Administration Building
100 Sherman Avenue, West Islip, New York 11795
TEL: (631) 893-3200 ⋅ FAX: (631) 893-3212

THIS FORM MUST BE COMPLETED BY THE PARENT OR GUARDIAN OR PERSON IN PARENTAL RELATIONSHIP.

IF YOU ARE REGISTERING FOR PRE-KINDERGARTEN, YOU MUST COMPELTE THE WEST ISLIP PRE-K REGISTRATION PACKET.

You do not need to register for kindergarten if your child already attends a West Islip district-provided pre-K program.

You can create an account (located at the bottom) and save the form as you are filling it out.

Registration is not complete until all requested forms have been received by the District Office during your appointment and the health information is confirmed by the school nurse.

Please enter your email address: * 🛈

Type of registration: *

New Kindergarten to Grade 12

Re-register Kindergarten to Grade 12

School Year: *

Student's Last Name: *

Student's First Name: *

Student's Sex: *

Female

Male

Nonbinary

Student's Date of Birth: * +

Student's City/State of Birth: *

Was the student born in the U.S.? *

Yes

No

If not born in the U.S., how many years has the student attended school in the U.S.?

Is the student Hispanic, Latino, or of Spanish origin? * 🛈

Yes

No

Select one or more races from the following five racial groups: * 🛈

Student's Legal Address: *

0/50 characters

Student's Zipcode: *

0/50 characters

Language spoken at home: *

Did the student receive English as a Second Language services in his or her previous district? *

Yes

No

Was the student still enrolled in these services upon withdrawal from the district? *

Yes

No

Has your child had any special education services (speech, resource room, counseling, etc.) through either previous schools or school districts, or is your child in need of any such services at this time? *

Yes

No

Are both parent's living in the home? *

Yes

No

Check all that apply: *

1st Parent's Last Name: *

1st Parent's First Name: *

Optional Title:

1st Parent's Phone Numbers (Include Area Code) * 🛈

	Home	Cell	Work
1st Parent	Home	Cell	Work

Parent 1 Email: * 🛈

1st Parent's Address (If different from the student):

0/50 characters

Is the 1st Parent a Non-Custodial Parent (entitled to receive mail)? *

Yes

No

Does not apply

1st Parent's Occupation: *

1st Parent's Employer: *

2nd Parent's Last Name: *

2nd Parent's First Name: *

Optional Title

2nd Parent's Phone Numbers (Include Area Code) * 🛈

	Home	Cell	Work
2nd Parent	Home	Cell	Work

Parent 2 Email: * 🛈

2nd Parent's Address (If different from the student):

0/50 characters

Is the 2nd Parent a Non-Custodial Parent (entitled to receive mail): *

Yes

No

Does not apply

2nd Parent's Occupation: *

2nd Parent's Employer: *

Are you a guardian other than the mother or father of the child? *

Yes

No

Guardian's Last Name: *

Guardian's First Name: *

Guardian's Phone Numbers (Include Area Code) * 🛈

	Home	Cell	Work
Guardian	Home	Cell	Work

Guardian Email: * 🛈

Guardian's Address (If different from the student): *

0/50 characters

Guardian's Occupation: *

Guardian's Employer: *

Do you have other children that are residents of the home? *

Yes

No

Additional Siblings

	First Name:	Last Name:	D.O.B (MM/DD/YY)	Gender:
1.	First Name:	Last Name:	D.O.B (MM/DD/YY)	Gender:
2.	First Name:	Last Name:	D.O.B (MM/DD/YY)	Gender:
3.	First Name:	Last Name:	D.O.B (MM/DD/YY)	Gender:
4.	First Name:	Last Name:	D.O.B (MM/DD/YY)	Gender:
5.	First Name:	Last Name:	D.O.B (MM/DD/YY)	Gender:
6.	First Name:	Last Name:	D.O.B (MM/DD/YY)	Gender:

Has any adult had a major part of your child’s care other than 1st or 2nd Parent? *

Yes

No

If yes, give names and relationships to your child. 🛈

+-

Are either of the student’s parents or guardians on active duty in the Armed Forces? * 🛈

Yes

No

Person to be called in case of emergency (other than parent/guardian): Last Name, First Name: *

Emergency Contact's Relationship to Student: *

Contact Phone Number: *

Doctor’s Name: *

Doctor's Phone: *

Is this application being filed by someone other than a natural, adoptive or step-parent? *

Yes

No

Specify reason for creating guardian/custodianship. *

0/255 characters

Does the student live in your home exclusively? *

Yes

No

Is this a temporary or permanent relationship? *

Temporary

Permanent

How long has the child lived with you? *

How often will the natural parent see the child? *

Do you have legal authorization to make medical decisions for the child for physicians and hospitals? *

Yes

No

Who has legal authorization to make medical decisions for the child for physicians and hospital? *