Kindergarten Registration Form

Ward L. Myers Elementary School Enrollment

Ward L. Myers Elementary School Enrollment

In addition to completing the on-line registration, you must complete and sign additional documents. These enrollment requirements will include: 1. Proof of the child's birth. Any one of the following constitutes acceptable documentation: birth certificate, notarized copy of birth certificate, baptismal certificate,copy of the record of baptism-notarized or duly certified and showing the dates of birth, notarized statement from the parents or another relative indicating the date of birth, a valid passport, a prior school record indicating the date of birth. 2. Documentation of immunizations required by law. Acceptabledocumentation includes the child's immunization record, a written statement from the former school district or from a medical office that required immunizations have been administered, or that a required series is in progress, or verbal assurance from the former school district or medical office that therequired immunizations have been completed, with records to follow. 3. Proof of residency. Acceptable documentation includes a deed, a lease, current utility bill, current property tax bill, current driver's license, DOT identification card. A district may require that more than one form of residency confirmationbe provided. However, school districts and charter schools should be flexible in verifying residency, and should consider what information is reasonable in light of the family's situation. 4. Parent registration statement (Expulsion affirmation statement) 5. Home Language Survey. All students seeking first time enrollment in a school shall be given a home language survey in accordance with requirements of the U.S. Department of Education's Office for Civil Rights.

Student Information

Legal Guardian Registrant Information

If the student is living with a resident adult other than a parent, please go to the For Parents/"New Student Registration" section of the Muncy School District Website to complete Attachment B. Print the completed form, have it notarized, and bring it to the registration meeting. If a court or dependency order or custody agreement is used as the basis for enrolling the child, a copy of said document must be provided.

Parent / Guardian #1 Contact Information

This is the legal parent/guardian with whom the student lives.

Parent / Guardian #2 Contact Information

This is the legal parent/guardian with whom the student lives.

Step-Parent/Guardian #1 Contact Information

Step-Parent/Guardian #2 Contact Information

I would like to add the following email addresses for receiving school and student information from Muncy School District in relation to my child(ren). These are in addition to the email addresses listed in the parent/guardian information.

If the student is under court order, please provide the following information from the court order.

Is the student ordered into?

If the answer above regarding emergency shelter cares was "Yes", list the date and contact person.

Information about Siblings

Sibling #1

Sibling #2

Sibling #3

Sibling #4

Sibling #5

Emergency Contact Information- Parents will be called first.
List those who should be called when parents cannot be reached.

Contact #1

Contact #2

Contact #3

Contact #4

Special Education Services

List the Agency and Dates that the student received any of the following prior treatment or support services or treatments within the last two years.

Inpatient Hospitalization

Outpatient Counseling

Drug and Alcohol Treatment

Vocational Rehabilitation

Residential Placements

Group Home Services


Has the student been involved with any of the following agencies within the last two years?

Children and Youth



Drug and Alcohol


List the names of any pre-school or Head Start programs the student has attended.
List Most Recent First

Completing this form is only one part of the registration process. Registration must be completed with Mrs. Kim Hill before any child may begin attending school. Please be prepared to submit the following documents to
Proof of Birth
Immunization Record
Proof of Residency (Utility Statement, Lease/Rental Agreement, Valid Drivers License, Tax Statement)
Custody Documentation (if applicable)
Copy of the Child's IEP (if applicable)
You will also receive a registration email containing: a Parental Registration Statement (Attachment A), a Home Language Survey, and an Internet & Technology Acceptable Use Policy that must be reviewed and signed for each registered child.
Please call 570-546-3125, ext. 2040 with any questions.