1. education
2. school

6th-12th Enrollment Application
Student Name:_________________________________
Grade Level: __________
For Enrollment Year:
___
AZURE CAMPUS
7485 W. Azure Dr.
Las Vegas, NV 89130
Phone: (702) 631-4751
Fax: (702) 586-0836
 E
In order
n to submit an application the following documentation MUST be submitted for your application
to be processed.
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o
l
 Enrollment Packet
l
 Birth Certificate
m
 Immunization Records
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n
 Parent ID
t
 Proof of Residence (Utility Bill)
 Transcripts (Most current grades)
P
(For Office
a Use Only)
c
Date Packet
k Returned________________
Sibling Names____________________________ Grade Level ________
e
t
Date Entered into SIS ________________
Sibling Names____________________________ Grade Level ________
 B
i
Start Date__________________________
Assigned Teacher______________________________________
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Student Enrollment Form
STUDENT INFORMATION
Name (Last, First MI)
Social Security Number
Home Address
Date of Birth
City
State
Home Phone (
Zip Code
Student Lives With (Check all that apply)

Stepmother
Race/Ethnic Background
 Hispanic
Home schooled 
Last School Attended
Gender  Female  Male Grade Entering
)
 Stepfather
Place of Birth

 Both Parents
 Father
 Mother
 Foster Parents
 Other (Please Specify)
 American Indian/Alaskan Native
 Black
 Caucasian (White)
Pacific Islander  Asian
FAMILY INFORMATION
Name: Mother/Guardian
Name: Father/Guardian
Home Address
Home Address
City
State
Zip Code
City
State
Home Phone
(
)
Home Phone
(
)
Mobile/Pager
(
)
Mobile/Pager
(
)
Social Security Number
Social Security Number
Employer
Employer
Employer Address
Employer Address
Business Phone
(
)
Business Phone
(
Zip Code
)
Email Address
Email Address
Hobbies or talents you are willing to share with our
students
Hobbies or talents you are willing to share with our
students
OTHERS LIVING IN THE HOME
Name
Age
Name
Age
Present School
Grade
Present School
Grade
Name
Age
Name
Age
Present School
Grade
Present School
Grade
EMERGENCY CONTACT INFORMATION
In case of an emergency or if I cannot be contacted to pick up my student, I hereby authorize the following person(s) for pick up:
Name
Home Phone (
Relationship
)
Work Phone (
Name
Home Phone (
)
Work Phone (
City
)
Work Phone (
)
City
Work Phone (
Zip Code
State
Zip Code
State
Zip Code
State
Zip Code
Address
)
City
Relationship
)
State
Address
Relationship
Name
Home Phone (
)
Relationship
Name
Home Phone (
Address
Address
)
City
I hereby permit the school to release my student to the above name person(s) upon my written or telephoned request.
Parent/Guardian Signature
Date
The following person(s) may NOT remove my student from campus
school.
Custody Papers on File
Name
 Yes
 No
Name
Name
HOW DID YOU HEAR ABOUT THE SCHOOL
 Direct Mail
 Newspaper
 Flyer
 Internet
 Passing By
 Magazine
 Word of Mouth
 Yellow Pages
 Other (Please Specify)
Medical Information Form
Medical History (Check all that apply)

Measles

Asthma

Allergies (food or otherwise)

Chickenpox

Vision Impairment

Physical Handicap

Mumps

Hearing Impairment

Diabetes

Scoliosis

Heart Condition
 Convulsive Disorder

Ear Infection

TB
Doctor’s Name
Phone
Hospital Preference
Phone
S
Is your Student Taking Any Medication?
 Yes
 No If yes, name the medication(s) and for what
ex
condition(s).
release form, available in the school office.
*Medication may not be administered without prescription
M
al Condition
Medication
e
 Condition
Medication
Fe
S
Medication
m Condition
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
al
Medication
Condition
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
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Is your student presently under treatment for any physical
M
e problem? If yes, please explain.

al

M
e
Fe
al

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e
Fe
al
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Is your student allergic to any foods or other substances?
e If yes, name foods or substances to be avoided.
Fe
al
Please explain procedure if reaction occurs.
m
e
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e
Is your student subject to convulsions, and what should be our procedure if one occurs?
Is your student usually susceptible to infections and if so, what precautions need to be taken?
Is there any physical condition that we should be aware of, and what precautions or procedures should be taken?
Additional Comments/Other Special Instructions
The above emergency and medical information is provided by:
Parent/Guardian Signature
Date

S
Locker Form
I acknowledge and understand that:
1. Student lockers are the property of Quest Preparatory High School.
2. Student lockers remain at all times under the control of Quest Preparatory High School.
3. Students are expected to assume full responsibility for their locker.
4. Students are not permitted to use private locks on school lockers.
5.
5. Students will pay a fee of $10.00 for the use of the locker for the school year. Use of lockers is optional. There is
no reimbursement of this fee.
Quest Preparatory High School retains the right to inspect student lockers for any reason at any time without notice,
without student consent, and without a search warrant.
*This form must be properly completed and returned to school authorities before a locker will be issued.
Student’s Name: ___________________________________________________________
Student’s Signature
Date:___________________
Parent/Guardian Signature
Date: _________________

S
p
First Aid Release
I hereby give consent for my student to receive the following over-the-counter medications (check all that apply) from the
Quest Preparatory staff. Quest Preparatory staff will administer first aid only as needed.

Bandages

Antiseptic

Ice Packs
Student’s Name (Please Print)
Parent/Guardian Name (Please Print)
Parent/Guardian Signature
Date
Home Language Form
In order for us to plan educational programs for our students and comply with the requirements of State Law,
please complete the following questionnaire. We appreciate your cooperation in providing this information.
Student
Date of Birth
Birth Place (City, State, Country)
Number of Years in School in the U.S.
Parent/Guardian
Relationship to Student
St===Pate
Is your child’s first language a language other than English?
Zip Code
 YES  NO
 If yes, what language
Is a language other than English spoken at home?
 YES
 NO
 If yes, what language
Does your child speak a language other than English with his peers (friends)?
 YES
 NO
 If yes, what language
If you have indicated a language other than English in the above responses, please complete the following.
What language does the mother speak to the student?
What language does the father speak to the student?
What language do the parents speak to the student?
What language does the student speak to the mother?
What language does the student speak to the father?
Has student participated in a school based bilingual program?
 Yes
 No
I hereby certify that the above information is true and correct.
Parent/Guardian Name (Please Print)
Parent/Guardian Signature
Date
Special Education Form
In order to provide continuity in the educational environment, it is important that Quest Preparatory be informed of any
special educational services received by your student in the past.
Student
Date of Birth
School
Grade
Was your student ever enrolled in any Special Education Programs?
 Yes
 No

If yes, please check all that apply.

Speech

Occupational Therapy
Learning Disability (LD) If yes, in what areas?

Physical Therapy
 Other (Please Specify)
Has your student been tested or evaluated for Special Educational Services?
 Yes
 No
*The Evaluations and/or supporting documents (Dr. reports, eligibility reports, MDT reports, psychological
evaluations, screening reports, etc.) to the IEP must be attached to the enrollment packet.
Does your student currently have an Individualized Education Plan (IEP)?
 Yes
 No
* The current I.E.P. must be attached to the enrollment packet.
Does your student currently have a 504 Accommodation Plan?
 Yes
 No
* The current 504 Accommodation Plan must be attached to the enrollment packet.
I hereby certify that the above information is true and correct.
Parent/Guardian Name (Please Print)
Parent/Guardian Signature
Date
Parent Survey
Please answer the following questions with as much information as possible.
Student
Date of Birth
Last School Attended
Grade
How did you learn about Quest Preparatory?
Has your student ever repeated a grade or been retained by another district?
 Yes
 No
Has your student ever been suspended by another district? If yes, please explain.
 Yes
 No
Has your student ever been expelled from school?
 Yes
 No
From what school
Date(s) of Expulsion
Comments
How does your student relate to authority? Does your student resist authority?
How does your student get along with other children?
Has your student participated in any extra-curricular activities? If yes, please list below.
 Yes
 No
Please describe any special needs your student might have.
I hereby certify that the above information is true and correct. I understand that misinformation may result in
dis-enrollment. Quest Preparatory does not accept students who have been expelled from other schools.
Official enrollment begins on the first day of school.
Parent/Guardian Name (Please Print)
Parent/Guardian Signature
Date

S
p
Request for Student Records
Student
Social Security Number
Home Address
Date of Birth
City
State
 Female
Gender
Zip Code
 Male
Home Phone
Parent/Guardian
Requested From (in order from most recent school attended)
S
ex

M Last School Attended
Last School Attended
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e
 Address
Address
F
e
City
State
Zip Code
City
State
m
al
e
Last School Attended
Last School Attended
Address
Zip Code
Address
City
State
Zip Code
City
State
Zip Code
Information requested consists of:









Withdrawal Form from previous school
Official transcript
Immunization Record
Birth Certificate
Withdrawal Grades and Date of Withdrawal
Testing Data and Results
Legal Guardianship or Custody Papers
Current IEP and Psych Evaluation
Ell Testing and Results
The Federal Law 99.31 allows for educational records to be sent to other educational agencies without the parent’s signature.
Send Records To:
7485 W. Azure Dr.
Las Vegas, NV 89130
Phone: (702) 631-4751
Fax: (702) 586-0836
First Request
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
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e

Second
F Request
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Third Request
Student Media Release
Throughout the school year, photos are taken of students during school events and functions for the yearbook, school
Website, Facebook page, etc. Quest loves to highlight student achievement, talent, and accomplishments; however, we
want to secure parental permission before publishing information about any child. This form will allow your child’s name
and/or photograph to be used in any of the school’s media.
Student Name
Grade
Teacher
 YES, I give permission for my student’s name and/or photograph to be used in any of the Quest Prep Academy
media.
 NO, I do not want my student’s name and/or photograph to be used in any of the Quest Prep Academy media.
Parent/Guardian Name (Please Print)
Parent/Guardian Signature
Date