324 North Highland Street
Gastonia, NC 28052
P: 704.866.6342
F: 704.866.6341
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ENROLLMENT

Haga clic aquí para obtener el formulario de inscripción en español.

Highland Charter Public School is currently accepting applications for Kindergarten through 5th grade for the 2011-2012 school year. Applications are available at the school (324 N Highland Street), any Gaston County Head Start Centers, or completed online. Call 704-866-6342 to arrange a tour of the school or for more information.

Complete the enrollment form and submit with the following:

  • Certified birth certificate
  • Updated Immunization record
  • Health assessment (Kindergarten only)
  • Social Security Card

Submit enrollment information by:
Email: enrollment@highlandcharter.org
Fax: 704-866-6342
Mail: Highland Charter Public School
P O Box 1653
Gastonia, NC 28053-1653

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Enrollment Form

Date: 2/22/2012 NCWISE #:
Name and address of previous school:
Grade: Teacher:
Name: Race: Sex:
Last First Middle
Name child is called:
Birth Date:   ,  Birthplace:
Month Day Year City County State
Mailing Address:
Home Telephone:
Street Address
City State Zip
Street Address (if different than mailing address):

Family

Father

Birth Date:   , 
First Middle Last Month Day Year
Birthplace: Last grade in school:
Occupation: Where employed:
Business Telephone: Cell Phone:

Mother

Birth Date:   , 
First Middle Last Month Day Year
Birthplace: Last grade in school:
Occupation: Where employed:
Business Telephone: Cell Phone:
Other (please specify):
Number of brothers and sisters: Number older: Boys: Girls:
Number younger: Boys: Girls:
Others at home:
Name Age Relationship

Travel and After School Care

With whom does child stay after school? Phone:
Child gets home by: Name of day care center:

HEALTH

** NC law requires a complete immunization record within 30 days of enrollment. The parent/guardian must present this record to avoid suspension. **
A.
If your child becomes too ill to remain in school and neither parent can be located, give NAMES and PHONE NUMBERS of TWO persons who will be responsible for picking up your child.
1.
Name Address Phone
2.
Name Address Phone
B.
If your child is injured at school, parents will be notified. If something needs to be done before parents can get to school, what do you want done?
C.
Permanent or long-term health problems.
Please check below if your child has a chronic health problem:
Other (please specify):
List medical procedures which might need to be administered at school:
D.
Will your child routinely need medicine during school hours?
Include medicines such as inhaler or Epipen which be available at school. If yes, an "Authorization for Medication" form must be requested from the teacher and be completed by your child's doctor and signed by you.
E.
Name of child's doctor:
Name of child's dentist:
F.
Any additional information which might be helpful to the school in working with your child:
Highland Charter Public School is open to any North Carolina resident, and will not discriminate against any applicant on the basis of ethnicity, national origin, gender, religion, or disability.
By submitting this form, you are signifying that you are the parent or guardian of this child.
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