Spark Charter School
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Spark Charter School
Fall 2015
KINDERGARTEN Registration
*
Indicates required field
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)
Register