Welcome to Hillcrest Middle School!

Date_________________________________        SS#__________________________________________

STUDENT'S FULL NAME________________________________________ BIRTH DATE_______________
                                     Last                        First                       Middle

NAME CALLED________________________            SEX________________          RACE_____________

ADDRESS______________________________________________________________________________
               Number, Street                                        City                               State                      ZIP

Entering Grade______________    Has this student ever repeated a grade?________    Which grade?____

HAS THIS STUDENT EVER ATTENDED A GREENVILLE COUNTY SCHOOL? ______________________

If so, what school?_____________________________________

Name of last school attended_______________________________________________________________

Address of last school_____________________________________________________________________

FATHER'S NAME_________________________________ MOTHER'S NAME________________________
                             (If parents are divorced, custody papers are required to register student).

NAME OF LEGAL GUARDIAN___________________________ Relationship (if applicable)______________ 
(Legal guardian as appointed by court order. A copy of document must be provided for student's permanent record).

HOME PHONE NUMBER____________________ EMERGENCY PHONE NUMBER___________________

Father's Business Phone____________________Father's place of employment________________________

Mother's Business Phone____________________Mother's place of employment_______________________

Step-parent's Name________________________ Step-parent's business phone________________________

Average grades -            A's        B's        C's        D's  and below

Does the student have any physical problem which may affect school attendance?______________________

__________________________________________________________________________________________

Has the student been in any special programs? (Academic, Remedial, Music, Art, Special Education)______

__________________________________________________________________________________________

8th Grade Only - (High School credit given)

________ Honors Algebra I          ___________Algebra I          _________ French

I certify that the above information is correct. ______________________________________________________
                                                                                                           Parent/Guardian Signature