Student Online Registration Form

Only the parent/guardian (F.S. 1000.21(5)) who registers the student (i.e., completes this form), or others identified below, may withdraw the student from his/her current school, unless there is documentation of extenuating circumstances indicating otherwise. If the information below changes, it is the parent's/guardian's responsibility to notify the school within 10 school days.

For which school year are you applying? *
For which grade level are you applying? *
For which session are you applying?
Student Name:
Name * First Middle Last
Contact Information:
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone * - ### - ### ####
Cell Phone * - ### - ### ####
Email *
F.S.I. *

(F.S. 1008.386 requires SBBC to request this information for the student's permanent record)
S.S.N. *
Ethnicity
Is the student of Hispanic, Latino or Spanish origin? *
Yes No
Race *
White American Indian/ Alaskan Native African American Native Hawaian / Other Pacific Islander
Sex *
Male Female
Current Grade Level *
Birth date and place
Date * / MM / DD YYYY
Has the student previously attended a:
Broward Public School
Yes No
School:
Private School
Yes No
School:
Florida Public
Yes No
School
County
Outside of Florida
Yes No
School:
County
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Public Private Other
Has the student ever been
Retained? *
Yes No
Grade(s)
In a home education program? *
Yes No
If yes, name of county/state/country
Dates of attendance / MM / DD YYYY
/ MM / DD YYYY
in Exceptional Student Education (ESE)?
Yes No
Program
In a Magnet Program?
Yes No
Program
Expelled from school? *
Yes No
Convicted of felony? *
Yes No
Is a language other than English used in the Home? *
Yes No
If yes, language used
Would you like to receive information in this language?
Yes No
Does the student have a first language other than English? *
Yes No
Does the student most frequently speak a language other than English?
Yes No
If yes, language spoken
Student lives with:
Both Parents Mother Father Other (Relationship to Student):
Marital status of parents (optional):
Married Divorced Separated Widow(er) Other
Notes:
Parent Name *
Parent signature *

Clear
Typing your name will represent your signature.
Date / MM / DD YYYY
Does anyone else have the right to withdraw your student from this school? *
Yes No
Name
Name * First Last
The above information is correct and complete to the best of my knowledge. In the event of a change of name, address, or phone, I will notify school staff within ten (10) days. I understand that students whose parents are found, after appropiate investigation, to have submitted fraudulent information in an effort to enroll a student in a school to which the student is not assigned shall be inmediately withdrawn by the school and the parent must enroll the student in the appropiate boundaried school. Ihave read and understand the Providing Proof of Residence: Important Information for Parents (SBP.5.1) and understand that if I have provided fraudulent information, I may be referred to law enforcement for prosecution.
Date / MM / DD YYYY
Type the letters you see in the image below.

Student Online Registration Form

Student Online Registration Form

Student Name:

Contact Information:

Ethnicity

Birth date and place

Has the student previously attended a:

Has the student ever been