REGISTRATION

To apply, please fill out the following form. If you have any questions or need assistance, contact Sherida Williams at (314) 531-9820 or email her at swilliams@lasallemiddleschool.org.

STUDENT INFORMATION

Child's Legal First Name

Child's Legal Last Name

Child's Preferred Name

Child's Social Security Number

Date of Birth

Current Grade level 5678


FAMILY INFORMATION

Primary Adult Parent/Guardian

Primary Adult Parent/Guardian Email

Parental Status ParentFosterNon-Parent

Number in Household

Number of Children Under 18

Street Address

City/State

Zip

Home Phone

Work Phone

Alternate Contact Name

Alternate Contact Phone


SCHOOL INFORMATION

Current School Name

Street Address

City/State

Zip

Phone

Years Attended

My child has, in the past, qualified for free or reduced lunch YesNoUnsure

How Did You Hear About Us?

I Agree I hereby agree to allow all pertinent educational and medical records to be released toLa Salle Middle School from the current educational facility/district in which the child has been in attendance. Specific information requested includes standardized test results, attendance records, health records, discipline records, diagnostic testing, medical needs, documentation of diagnosis with educational recommendations special education(original evaluations, all re-evaluations, current EIP, leaning profiles, and/or504 plan).