Registration Kindergarten

Spark Charter School
Fall 2015

KINDERGARTEN Registration

Do you wish to accept your offer to enroll this student? *

Yes No

Parent Name *

First

Last

Parent Email *

STUDENT INFORMATION

Student's Name

First *

Middle *

Last *

Spark will transfer all basic data from your application for this student.
Please provide the additional enrollment information below

Last School Attended *

City *

District *

Does this student have any serious allergies? *

Yes No

If yes, please list *

Does this student require any medications, such as an Epipen, to be kept in the school office? *

Yes No

HEALTH CARE PROVIDERS

Primary Care Physician

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Insurance Provider *

Insurance ID # *

Dentist

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

EMERGENCY CONTACT #1
(Other than parents)

Name *

First

Last

Relationship to student *

Home Phone *

Cell Phone *

Work Phone *

Email *

EMERGENCY CONTACT #2
(Other than parents)

Name *

First

Last

Relationship to student *

Home Phone *

Cell Phone *

Work Phone *

Email *

IMPORTANT: In order to complete the registration process, you must mail a copy of the following to:

Spark Charter School--Student Registration
PO Box 60416
Sunnyvale, CA 94088

Due now:

Proof of age: copy of birth certificate or passport for the student
Proofs of residency (in-district applicants only):

a. One of the following: Rental agreement, lease, monthly mortgage payment, or property tax bill showing name and address
b. One of the following: PG&E, water, cable, or phone bill showing name and address

Due May 31, 2015:

Signed release to transfer student records (to be provided)

Due July 31, 2015:

Kinders only: Report of health exam, including TB risk assessment (click here for health form. Click here for requirements)
Kinders only: Oral health exam (click here for form. Forma en espanol)
Signed fingerprint / background check release form for designated parent volunteer(s) (to be provided)

Due from parents before the start of volunteering (Please provide by August 31st):

Picture ID
Proof of fingerprint / background check.
Proof of negative TB test (valid for 4 years)
Proof of adequate auto insurance for each anticipated field trip driver (minimum $100,000 per occurance)

Spark Charter SchoolFall 2015

Spark Charter School
Fall 2015