Emmerich Manual High school logo

Registration for the 2013-14 school year

Please fill out the form below to begin the registration process for the 2013-2014 school year:
Prefix:
First Name: *
MI:
Last Name *
Email
Home Phone

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Work Phone

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Cell Phone

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Street Address: *
City:
State:
Zip
County:
Please check one. I prefer to be contacted by *
 Phone 
 Email 
Please write in the school year you are applying for:
How did you hear about the school?
Student Name 1
First, MI, Last
Relationship to student
Gender
 Female 
 Male 
Date of Birth
Previous School Name
State
County
For which grade level are you applying for?
 9 
 10 
 11 
 12 
Student Name 2
First, MI, Last
Relationship to student
Date of Birth Student 2
Gender Student 2
 Female 
 Male 
Previous School Name Student 2
State Student 2
County Student 2
For which grade level are you applying for Student 2?
 9 
 10 
 11 
 12 
Check if you agree *
  To the best of my knowledge, the above information is correct and complete. I understand any false statements may result in forfeiting my child's seat.In the event of a change of address, phone, name, etc. I will contact the school. 
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