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Lebanon BoroughSchool District

students acting on stage in a play

Student Registration Information

Welcome to the Lebanon Borough School Family! We look forward to having your child join us. Please take a moment to fill out our student registration information below.

Registration Date:

MM slash DD slash YYYY

Grade Entering:

Child's First Name:

Child's Middle Name:

Child's Last Name:

Child's Nickname:

Child's Primary Language:

Child's Address:

Child's Date of Birth:

Please select below if your child is male or female.

Male

Female

Place of Birth:

Date of Entry into US if Born Outside of US:

Home Telephone Number:

Please select below if your home telephone number is listed or unlisted.

Listed

Unlisted

Email Address:

Cell Phone Number:

Parent/Guardian Information

Parent/Guardian Name:

Occupation:

Employer's Name:

Employer's Address:

Employer's Telephone Number:

Please check the highest grade completed:

Elementary

High School

Vocational School

Some College

Undergraduate Degree

Graduate Degree

Parent/Guardian Name:

Occupation:

Employer's Name:

Employer's Address:

Employer's Telephone Number:

Please check the highest grade completed:

Elementary

High School

Vocational School

Some College

Undergraduate Degree

Graduate Degree

Marital Status of Parents

Please check one:

Married

Divorced

Separated

Widowed

If separated or divorced, who has custody?:

Doe your child see the non-custodial parent?:

Yes

No

N/A

If yes, how often?:

Please list other important adults in your child's life:

Emergency Information

Alternate Contact Person:

Pertinent Telephone Number(s):

Relationship:

Family Record

Child's Status in Family:

Oldest

Middle

Youngest

Only Child

Multiple Birth

Name, birth date, age, and grade of other children:

Any significant difficulties in school?

Yes

No

If yes, which child?

Please explain nature of difficulty:

Are there any recent changes in family life?

Yes

No

If yes, please explain (i.e. birth, death, divorce):

Do you have any concerns about your child's development?

Yes

No

If yes, please explain:

What language(s) is spoken at home?:

Child's Preschool History

Did your child attend preschool?

Yes

No

If yes, what is the name of the preschool:

If yes, what is the address of the preschool:

If yes, what is the phone number of the preschool:

If yes, may we call your child's preschool?

Yes

No

Number of years attended preschool:

Days per week:

Dates of attendance:

Child's Elementary School History

Please list most recent school first.

School Last Attended:

Date of Entrance:

Date of Leaving:

Reason for Leaving:

School Last Attended

Date of Entrance:

Date of Leaving:

Reason for Leaving:

School Last Attended:

Date of Entrance:

Date of Leaving:

Reason for Leaving:

Additional Comments

Please enter additional comments about your child:

Δ

Hand holding a pen filling out a registration form

Lebanon Borough School District

6 Maple Street, Lebanon, NJ 08833

P: 908-236-2448
|F: 908-236-7670

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