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Date: ___________________
Georgetown County School District Homeroom: _________________
Registration Form (Check if completed)
Registration Form
Emergency Card
S.C. Health Dept. Certificate
Lunch Form
Please Print Transcript Request
Social Security Number: _ _ _ -_ _ -_ _ _ _ Birth Certificate Number _____________________________
____________________, ______________________ _________________ (____________________)
LAST NAME FIRST NAME MIDDLE NAME NAME CALLED
Date of Birth: _ _/ _ _/ _ _ _ _ Sex: _____________ Grade Level: _________________
Place of Birth: ____________________________, ___________________ ________________________
CITY STATE COUNTRY
Ethnic Code: _____________ (AI= American Indian/Alaskan Native; AP= Asian or Pacific Islander; B= Black;
H= Hispanic; W= White)
911 (Street) Address: ________________________________________________________________________
Mailing Address (if different): _________________________________________________________________
City: ___________________________ State: ______________________ Zip Code: ____________________
Home Telephone Number: __________________________________
Family Information
Father’s Name: ___________________________________ Occupation: _____________________________
Place of Employment: _____________________________ Telephone: ______________________________
Mother’s Name: __________________________________ Occupation: _____________________________
Place of Employment: _____________________________ Telephone: ______________________________
With whom does the child live? ______________________ Relationship: ____________________________
Name of brothers/sisters attending Georgetown County Schools:
Name School
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Home Language
What language did the child learn to speak first (i.e., native language)? _________________________________
What is the primary language spoken in the home? __________________________________________________
What language does the child use most? ___________________________________________________________
Needs
Name problems that might affect your child’s schooling ______________________________________________
___________________________________________________________________________________________
Did your child receive special education services at his/her previous school? ( ) yes ( ) no
Did your child receive gifted and talented services at his/her previous school? ( ) yes ( ) no
Alternate Person to Notify
Name: _________________________________________________ Telephone: __________________________
Relationship to Child: _________________________________________________________________________
Name of person(s) picking up your child if not a bus rider: ____________________________________________
Bus Information
Do you desire bus transportation? ( ) Yes ( ) No Directions to your house: ______________________________
___________________________________________________________________________________________
Parent’s Signature: _____________________________________ Date form completed: ______________
Office use:
Copies of 2 proofs of residency are attached. ( ) yes ( ) no
Signature of office personnel who registered student and verified proofs of residency:
______________________________________ Date: _____________________________________
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GEORGETOWN HIGH SCHOOL
HOME LANGUAGE SURVEY
(Please print)
Student Name:
_________________________, ______________________, _________________
Last Name First Name Middle Name
Date of Birth: _____/______/_____ Sex: _________________
Place of Birth: _____________________________ ______________________
City State
_____________________________
Country
Ethnic Code: ____________ (AI= American Indian/Alaskan Native; AP= Asian Or
Pacific Islander; B= Black, H= Hispanic; W= White)
What language did the child learn to speak first (i.e., native language)?
What is the primary language spoken in the home?
______________________________________________________________________________
What language does the child use most?
______________________________________________________________________________
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ADDITIONAL VERIFICATION OF RESIDENCY
Vehicle Information
I understand that, unless special arrangements have been made, my child’s primary residence must be in
Georgetown County, South Carolina, in order for me to register
_________________________________________ (Child’s Full Name), in
___________________________________________ School.
The license plate numbers and state of registration for vehicles owned by our family members that may
be driven or parked on school grounds are as follows:
License State of If vehicle is registered in S.C.,
Number Registration is it registered in Georgetown County?
__________ _____________ Yes. _____No: registered in __________Co.
__________ _____________ Yes. _____No: registered in __________Co.
__________ _____________ Yes. _____No: registered in __________Co.
__________ _____________ Yes. _____No: registered in __________Co.
My street address (a P.O. Box address is not acceptable), work address, and telephone number(s) are as
follows:
Street address: ________________________________________
City, State, Zip: _______________________________________
Home Telephone: _____________________________________
Work address: ________________________________________
City, State, Zip: _______________________________________
Work Telephone: _____________________________________
I understand that the foregoing information may be used by Georgetown County Schools or shared with
appropriate state or county agencies for purposes of determining residency and for complying with
South Carolina statutes.
Signature: ____________________________________
Date: __________________________________
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Georgetown High School
Guidance Department
P. O. Box 1778 2500 Anthuan Maybank Drive Georgetown, SC 29442-1778
Telephone: (843) 546-8516
Fax: (843) 527-3492 or (843)546-8521
REQUEST FOR RECORDS
DATE: ___________________
TO: ____________________________________________________________________
________________________________________________________________________
STUDENT: ________________________________ GRADE: _____________________
DATE OF BIRTH: _____________________
The student listed above has enrolled at Georgetown High School. Please send a complete transcript or
the student’s records including the following:
Dates of Entry and Withdrawal
The student’s transcript
Current Report Card
The grades of courses in which the student is currently enrolled
Grading scale-credit/unit system and number of credits required for graduation
Standardized test scores
Health/Immunization records
Copy of Birth Certificate & Social Security card
Special Education records (if applicable)
Discipline Records
If the student withdrew prior to the end of a grading period, please list the courses/subjects she/he was
taking and the grades for that grading period to date of withdrawal.
____________________ _________ ____________________ __________
Parent/Guardian Date Counselor Date
____________________ _________ ____________________ __________
Student Date Secretary Date
**Parental permission is not required when records are requested by authorized school personnel
(Family Educational Rights and Privacy Act (FERPA), 34 CFR, Section 99.31.
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State of South Carolina
County of Georgetown
AFFIDAVIT
1. Caretaker’s Name__________________________________________________________
I live at___________________________________________________________________
I get my mail at____________________________________________________________
Telephone Number____________________ (Home) _______________________ (Work)
2. The child(ren), _____________________________________________, has lived with me since
__________________. The child(ren)’s relation to me is _____________________.
He/She will be attending school at __________________ and will be in the _____ grade. The
child(ren)’s Parent’s/Legal Guardian’s names:______________________________.
3. The child(ren) is living with me and is qualified to attend school in this Georgetown County
School District because: (check one)
I have legal custody of the child(ren) (copy of custody papers required).
I am the child(ren)’s foster parent, licensed by the Department of Social Services.
The child(ren) lives at ____________________________________, which is a facility
licensed or operated by the Department of Social Services or the Department of Youth
Services (circle one).
The child(ren)’s mother/father (circle one or both) is dead or seriously ill and unable to
care for the child(ren) or is in jail or prison
(explain)._______________________________________________________________
_______________________________________________________________________
The child(ren)’s mother/father (circle one or both) left the child(ren) with me. I have
complete control of the child(ren) as shown by the mother’s/father’s failure to provide
substantial financial support and parental guidance.
The child(ren) was being abused or neglected by a parent or legal guardian. (Note: The
school is required by law to report suspected child(ren) abuse or neglect.)
The child(ren)’s mother/father (circle one or both) has a physical or mental condition
which prevents her/him from providing adequate care or supervision for the child(ren).
The child(ren) is emancipated from the control of his/her mother and father.
The child(ren)’s family does not have a fixed, regular and adequate nighttime residence or
a nighttime residence that is a shelter or institution that provides temporary living
accommodations.
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Affidavit
Page 2
4. As a parent/guardian, I agree to allow ____________________________ access to the
items listed below: (Name of Caretaker)
Making sure the child(ren) attends school regularly.
Accepting notices about the child(ren)’s behavior and taking part in any required
meetings with school officials.
Signing the child(ren)’s report card.
Signing permission slips for field trips and athletic activities.
Cooperating with the district, parents or any surrogate parent if the child(ren) needs
special education services.
Informing the school district of the addresses of the parents, if known.
Notifying the school if the child(ren) returns to his/her parent(s) or other person with
legal custody.
I understand that I am signing this affidavit under penalty of perjury. I understand that I can be
fined up to $200 and/or sent to jail for up to 30 days if I do not tell the truth. I also understand
that I may have to pay the district the cost of educating the child(ren) if I do not tell the truth.
_____________________________________ _____________________________________
Parent/Guardian’s Signature Date Caretaker’s Signature Date
Sworn to before me this ______________________day of _______________________, 200_.
_______________________________________ ____________________________________
Notary Public of South Carolina Commission Expires
NOTE: If it is found that information contained in this affidavit is false, the child(ren) must be
removed from school. The District will give notice of an opportunity to appeal the removal in
accordance with the appropriate District grievance policy.
Requesting Transfer From:_______________________ To: __________________________
(Name of School) (Name of School)
Approved__________ Denied__________
AUTHORIZED SIGNATURE: ___________________________ DATE:_______________
JAMES T. DAVIS
COORDINATOR OF STUDENT SERVICES
JH 2/26/08
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