HCCSC New Student Information

New Student Enrollment Information

This form is to be filled out for student's who are new to HCCSC or a returning student who is not currently enrolled with HCCSC this school year.
Please note, If you are completing this form for PreSchool registration we have limit openings and you must contact Laura Lahr before completing this form at 260-356-7612 x3224 . Completing this form does not guarantee placement in PreSchool.
Has your student ever attended HCCSC in a previous school year?*

YesNo
Date student will start at HCCSC (first date of 24.25 school year is Aug. 7th, 2024)*

MonthDayYear
Date
Grade of Student*
Grade of Student -Text
Name of School your Student will be attending?*
Pre-K Principal Email
example@example.com
MUST be 5 years of age on or before August 1st of the year they begin kindergarten.
Email of Secretary 1
example@example.com
Transportation Routing Secretary
example@example.com
Legal Name of Student*

First NameMiddle NameLast Name
Nickname or Child's preferred name:

First NameLast Name
Legal Gender
Date of Birth*

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address(if different than home address)
Upload Proof of Residency:

Please upload a picture of a document or a piece of mail with your current address. If you can not provided this as an attachment you will be required to bring a copy to the student's school on their first day of school.
Cancelof
Student Home Language*
Hispanic (choose one)

YesNo
Ethnicity of Student*

American Indian/Alaskan NativeBlackAsianHispanic and of any raceWhiteMultiracial (two or more races)Native Hawaiian or other Pacific Islander
Country of Origin
Parent/ Guardian Email*
example@example.com
Student Lives with/Relationship to the student*
Both Parents, Mother, Father, Step-Parent, Grandparent, Foster Parent, etc...
Male Head of Household- Name

First NameLast Name
Relationship to Student
Phone Number for Male Head of Household
Female Head of Household- Name*

Last Name
Relationship to Student*
Phone Number for Female Head of Household*
List Non Custodial Parent (if any)
Phone Number of Non Custodial Parent
If you have guardianship of said student, has legal documentation been turned into the school?

YesNo
Will your student have a Day Care Provider?*

YesNo
Day Care Provider - Name
Day Care Provider - Phone
Day Care Provider - Address
Will your student be using HCCSC Transportation (busing)?*

YesNo
Transportation Information:

My child will be picked up and dropped off at the home address each dayMy child will be picked up and dropped off at child care provider each dayMy child will be picked up at home and dropped off at child care provider each dayMy child will be picked up at child care provider and dropped off at home each dayMy child will be picked up at home and dropped off at Huntington Boys and Girls Club each dayMy child will be picked up at Huntington Boys and Girls Club and dropped off at home each day.I will provide transportation for my child to and from school each day.I will provide transportation for my child in the AM and dropped off at the home address each day.I will provide transportation for my child in the AM and dropped off at child care provider each day.I will provide transportation for my child in the AM and dropped off at Huntington Boys and Girls Club each day.My child will be picked up at home in the AM and I will provide transportation for my child in the PM.My child will be picked up at child care provider in the AM and I will provide transportation for my child in the PM.My child will be picked up at Huntington Boys and Girls Club in the AM and I will provide transportation for my child in the PM.My child will drive their own vehicle to and from school each day.My child will drive their own vehicle to and from school each day.
Username for Parent PowerSchool account (login info)*
A password will be given to you by the school secretary. You will be prompted to change it when you log into PowerSchool.
Name of Previous School*
Address of Previous School *

Address

Street Address Line 2

CityState

Postal / Zip Code
Phone number of Previous School *
Fax number of Previous School
Did your child attend preschool?

YesNo
Name of Preschool:
Does your child receive speech services through HCCSC?

YesNo
Would you like information on your student attending Kinder Kamp?

YesNo
Has your child attended a school in Indiana?*

YesNo
Do you have any other siblings enrolled in Huntington County School?*

YesNo
Name of Sibling(s) and grade level:
Please list all siblings
Does your child have a 504 plan?*

YesNo
Does your child have an IEP?*

YesNo
Does your child have an ILP? (Individualized Learning Plan-English Learner)*

YesNo
Has your child ever attended HCCSC?*

YesNo
Does your child want to be enrolled in: (if no, leave blank)

BandChoir
Is your family on assistance? (Medicaid)*

YesNo
Today's Date*

MonthDayYear
Date
Parent/Guardian Signature*

Clear
Should be Empty:

New Student Enrollment Information

MUST be 5 years of age on or before August 1st of the year they begin kindergarten.