Clone of WILD Enrollment Form

Meeteetse School Enrollment Form
Student Information
Student 1 Legal Name

First NameMiddle NameLast Name
Student 1 Preferred Name / Nickname
Student 1 Date of Birth

MonthDayYear
Date
Student 1 Grade
Student 1 Gender / Sex

Other
Student 1 Primary Language Spoken at Home
Student 1 Federal Ethnicity and Race

Other
Student 1 Additional Ethnicity / Race Details
Do you have another student to enroll
Student 2 Legal Name

First NameMiddle NameLast Name
Student 2 Preferred Name / Nickname
Student 2 Date of Birth

MonthDayYear
Date
Student 2 Grade
Student 2 Gender / Sex

Other
Student 2 Primary Language Spoken at Home
Student 2 Federal Ethnicity and Race

Other
Student 2 Additional Ethnicity / Race Details
Do you have another student to enroll
Student 3 Legal Name

First NameMiddle NameLast Name
Student 3 Preferred Name / Nickname
Student 3 Date of Birth

MonthDayYear
Date
Student 3 Grade
Student 3 Gender / Sex

Other
Student 3 Primary Language Spoken at Home
Student 3 Federal Ethnicity and Race

Other
Student 3 Additional Ethnicity / Race Details
Do you have another student to enroll
Student 4 Legal Name

First NameMiddle NameLast Name
Student 4 Preferred Name / Nickname
Student 4 Date of Birth

MonthDayYear
Date
Student 4 Grade
Student 4 Gender / Sex

Other
Student 4 Primary Language Spoken at Home
Student 4 Federal Ethnicity and Race

Other
Student 4 Additional Ethnicity / Race Details
Household & Address
Household Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Is this address temporary, a shared housing, a shelter, a hotel, a campground, a vehicle, or an abandoned building?
Mailing Address (if different)
Parent/Guardian Information
Parent/Guardian 1 Full Name

First NameMiddle NameLast Name
Parent/Guardian 1 Relationship to Student
Parent/Guardian 1 Email
example@example.com
Parent/Guardian 1 Preferred Language
Parent/Guardian 1 Cell / Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Mailing Address if Different
Parent/Guardian 1 Lives with Student
Parent/Guardian 1 Has Legal Authority for Educational Decisions
Additional Parent/Guardian 1 Contact Notes
Is there an additional Parent/Guardian?
Parent/Guardian 2 Full Name

First NameMiddle NameLast Name
Parent/Guardian 2 Relationship to Student
Parent/Guardian 2 Email
example@example.com
Parent/Guardian 2 Preferred Language
Parent/Guardian 2 Cell/Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Mailing Address if Different
Parent/Guardian 2 Lives with Student
Parent/Guardian 2 Has Legal Authority for Educational Decisions (if answer is No, please provide court documents)
Additional Parent/Guardian 2 Contact Notes
Emergency Contacts 1 & 2
Emergency Contact 1 Name

First NameLast Name
Emergency Contact 1 Relationship
Emergency Contact 1 Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 1 Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Name

First NameLast Name
Emergency Contact 2 Relationship
Emergency Contact 2 Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Language and Culture Survey
Federal and state regulations require schools to determine the language(s) spoken and understood by each student. This information is necessary for schools to provide appropriate instruction. Thank you for providing this information.
Student(s) Name(s):
Parent(s)/Guardian(s) Name:
What language(s) did your child(ren) use when he/she first began to talk?
What language(s) does your child(ren) speak to you at home?
What language(s) do you (parents/guardians) use when you speak to your child(ren)?
Do the adults in your home (parents/guardians/grandparents/other adults) speak to each other in a language other than English on a daily basis?
If yes, what language(s) are spoken?
Does your child(ren) understand the conversation?
Does your child(ren) participate in the conversation even if he/she might use English?
What language(s) does your child(ren) read?
What language(s) does your child(ren) write?
Did your child(ren) attend school in another country?
If yes, which country and for how long ?
Do you need assistance in understanding any of our school forms?
Legal/Medical
Custody restrictions or court orders
Medical, allergy, or safety concerns
I as the parent of the listed student(s) listed above, realize that there is the risk of my child being injured that is inherent in all activities participation. I realize that the injury may be severe including the possibility of fractures, brain injury, paralysis or even death. I give my permission to allow my child(ren) to participate in all school activities (including athletic) for the 2026-2027 school year. I understand that my child(ren) will be expected to follow the activity regulations. I also understand that at any time I do not want my child to participate in any of the activities scheduled that I may call either the principal or sponsor of the activity and my child/children will not be allowed to participate in and/or go to the activity.
Do you authorize Park County School District #16 and its faculty members in charge of my child(ren) to obtain all necessary medical care for my child(ren) in the event that I cannot be reached to authorize it myself. I hereby authorize any licensed physician and/or medical personnel to render necessary medical treatment to my child(ren).
Needs, supports, or concerns
Parent Permission Form For Publishing Student Photographs and Student Work On The Park County School District #16 Website, The Meeteetse School Website, and In District-Related Publications
I understand that my child's photograph and class work could appear on the Park County School District #16 websites and publications throughout the year and that any such publication is not for profit and neither my child nor family will be compensated for such use.

I understand that no last names, home addresses, email addresses, or telephone numbers will appear iwth any photograph or published work. Students will only be identified by first name.

I also understand that Park County School District #16 has no control over non-District media sources and their use of my child's likeness, name and photograph.
Subject to the above conditions, do you grant permission for the publishing of the student's photograph and/or student work done by the Student(s) named above on the Park County School District #16 websites and any District-related publications?
Do you grant permission for Park County School District #16 to release my student's photograph and/or student work done by the student(s) named above to Local Newspaper (The Cody Enterprise, Meeteetse Community Bulletin, Northwest Wyoming Daily News, etc.), understanding that such newspapers may print your student's name in full along with any such photographs and/or student work, and that Park County School District #16 has no control over non-District media sources and their use of your child's likeness, name, or photograph?
Do you consent for the release of student directory information as it applies to school related activities such as; yearbook, athletics, musical programs, honors, awards, drama productions. commencement, etc/ This release shall not apply to confidential student records such as; test scores, transcripts, evaluations, etc. This consent will remain in effect unless or until permission is revoked by the parents requesting in writing such a revocations. (WY State Statue 15-442)
Signatures
By signing I certify that the information provided in this enrollment form is accurate to the best of my knowledge.
Parent/Guardian 1 Printed Name
Date

MonthDayYear
Date
Signature
Parent/Guardian 2 Printed Name
Date

MonthDayYear
Date
Signature
Should be Empty:

Meeteetse School Enrollment Form

Student Information

Household & Address

Parent/Guardian Information

Emergency Contacts 1 & 2

Home Language and Culture Survey

Legal/Medical

Parent Permission Form For Publishing Student Photographs and Student Work On The Park County School District #16 Website, The Meeteetse School Website, and In District-Related Publications

Signatures