2022-2023 Enrollment Application

Legal First Name

Legal Middle Name

Legal Last Name

Student's Birth Date

Month

Day

Year

City of Birth

State of Birth

Country of Birth

Gender

Residential Address (Street)

Residential Address (City)

Residential Address (State)

Residential Address (Zip)

Primary phone number to be called first in case of emergency

Who's Number Is This?

Student is a sibling of a current student

Parent/Guardian Information

Legal Parent/Guardian

First & Last Name

Relationship to Student

Address (if different than student's)

Best Contact Phone #

Type of Phone

Alternate Phone #

Type of Phone

Email
FYI: Most school communications will come via email

Parent/Guardian Rights

Contact Allowed

Has Custody

Mailings Allowed

Release To

Is this parent a member of the Armed Forces on Active Duty?
YesNo

Legal Parent/Guardian #2

First & Last Name

Relationship to Student

Address (if different than student's)

Best Contact Phone #

Type of Phone

Alternate Phone #

Type of Phone

Email

FYI: Most school communications will come via email

Contact Allowed

Has Custody

Mailings Allowed

Release To

Is this parent a member of the Armed Forces on Active Duty?
YesNo

Student Background

Previous School Name

Last Grade Completed

Is this student in foster care?
YesNo

Receiving Special Education Services?
YesNo
If so, what services?

Emergency Contacts

First & Last Name

Relationship to Student

Best Contact #

Language Information

State Board of Education Approved Home Language Survey^*

The Grand Rapids Child Discovery Center is collecting information regarding the language background of each
of its students. This information will be used by the district to determine the number of children who should be
provided bilingual instruction according to Sections 380.1151 - 380.1158 of the School Code of 1976, Michigan's
Bilingual Education Law. Would you please help by providing the following information?

Thank you very much
for your cooperation.

Is your child's native tongue a language other than English?

YesNo
If "Yes", what is that language?

Is the primary language¹ used in
your child's home environment a language other than English?
YesNo
If "Yes", what is that language?

¹ "Primary language" means "dominant language used by a person for communication."

^* Translation of the questions in this section in Spanish, Arabic, French, Italian, and Ojibwa is available at the Office of Field Service

Home Information

McKinney-Vento Questionnaire

In permanent housingIn a shelterIn transitional housingAwaiting foster care placement or within first 6 months of foster placementIn a hotel/motelWith another family or person because of loss of housing or economic hardshipIn a car, park, camper, abandoned building, etc. (unsheltered)Other temporary living situation
If "Other", please describe

Race & Ethnicity Information

Please answer both parts A and B

Part A. Is this student Hispanic/Latino? (check only one)

No, not Hispanic/Latino

Yes, Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.)

Part A of the question is about ethnicity, not race. Regardless of what you selected in Part A, please answer Part B by marking one or more boxes to indicate what you consider your student’s (or your) race to be.

Part B. What is the student’s race? (Choose one or more)

American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America, including Central America.)

Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.)

Black or African-American (A person having origins in any of the black racial groups of Africa.)

Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.)

White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)

NOTE: Both parts A and B must be completed. We encourage you to select an answer for both parts. If either part (A or B) is not answered, the U.S. Department of Education requires the school district to supply an answer on your behalf.

Thank you for completing the enrollment application for the Grand Rapids Child Discovery Center. Please review your answers and ensure all responses are answered to the best of your knowledge. When you have done so please click the button below.

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2022 - 2023

Application For Enrollment

Student Basic Information