Tiverton School District

Tiverton Public Schools

Early Risers K - 8 Registration Form 

Step 1: Student Information

Male Female

Date of Birth: (MM/DD/YYYY)

Student Name

(Last)

(First)

(Middle)

Address

(Number and Street)

(Town)

Rhode IslandAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming (State)

(Zip)

School They Attend

Fort BartonPocassetWalter E. RangerTiverton Middle School (Name of School)

PKK12345678 (Grade for School Year 20-21)

5 days per weekMon, Wed, FriTues, Thur (Select days)

Step 2: Family Information

1. Parent / Guardian Type: MotherFatherAuntFoster ParentGrand ParentLegal GuardianOtherSiblingStep MotherStep FatherUncle

Name

(Last)

(First)

(Middle)

(Email Address)

Address (if different from student)

(Number and Street)

(Town)

Rhode IslandAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming (State)

(Zip)

Home Phone:

Work Phone:

Cell Phone: Check here if you would like to receive texts

2. Parent / Guardian Type: MotherFatherAuntFoster ParentGrand ParentLegal GuardianOtherSiblingStep MotherStep FatherUncle

Name

(Last)

(First)

(Middle)

(Email Address)

Address (if different from student)

(Number and Street)

(Town)

Rhode IslandAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming (State)

(Zip)

Home Phone:

Work Phone:

Cell Phone: Check here if you would like to receive texts

Please use the text box below to list any medical concerns that our Early Risers Program providers should know about: 

Security Measure

google recaptcha