Student Information Update

Student Information Update 2026-2027

Pre-K - 12th Grade
What school does your student attend?
Student First Name
Student Middle Name
If no middle name put N/A
Student Last Name
Student Suffix
i.e. Jr, III
Grade
Grade for 26-27 School Year
Student Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student/WVEIS ID Number (if known)

Student Contact Information
Primary Phone Number
Number that will receive calls for school closures, attendance, etc. Format: 000-000-0000.
Does the student have an IEP or 504 plan?
Is there a custody agreement for your student?

Siblings in Jefferson County Schools
Sibling 1 Full Name
School Attending
Sibling 2 Full Name
School Attending
Sibling 3 Full Name
School Attending

Household Information

JCS recognizes that many of our students live in multiple households. To ensure we have the best contact information available for every student, please provide all available information for all households.
1 Household Families

If your student resides only in one household, you will put all information in Household 1. Parent/Caregiver 1 will be the primary contact, and Parent/Caregiver 2 will be the secondary contact. You will not put anything in for Household 2

2 Household Families

If your student resides in two households, Parent/Caregiver 1 in Household 1 will be the primary guardian, and Parent/Caregiver 1 in Household 2 will be the secondary guardian. Parent/Caregiver 2 in both households will be the tertiary or third guardian.
Does your student live in more than one household?
Household 1
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your physical address the same as your mailing address?
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Caregiver 1 - Full Name
Parent/Caregiver 1 - Relationship to Student
Parent/Caregiver 1 - Email
example@example.com
Parent/Caregiver 1 - Cell Phone
Please enter a valid phone number.Format: 000-000-0000.
Parent/Caregiver 1 - Landline or Home Phone
Please enter a valid phone number.Format: 000-000-0000.
Parent/Caregiver 1 - Employer
Parent/Caregiver 1 - Occupation
Parent/Caregiver 1 - Work Number
Please enter a valid phone number.Format: 000-000-0000.
Is a translator needed to communicate with Parent/Caregiver 1?
What language does Parent/Caregiver 1 speak?
- Parent/Caregiver 2 - Full Name
- Parent/Caregiver 2 - Relationship to Student
- Parent/Caregiver 2 - Email
  example@example.com
- Parent/Caregiver 2 - Cell Phone
  Please enter a valid phone number.Format: 000-000-0000.
- Parent/Caregiver 2 - Landline or Home Phone
  Please enter a valid phone number.Format: 000-000-0000.
- Parent/Caregiver 2 - Employer
- Parent/Caregiver 2 - Occupation
- Parent/Caregiver 2 - Work Number
  Please enter a valid phone number.Format: 000-000-0000.
- Is a translator needed to communicate with Parent/Caregiver 2?
- What language does Parent/Caregiver 2 speak?

Household 2
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your physical address the same as your mailing address?
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Caregiver 1 - Name
This will be the student's secondary guardian.
Parent/Caregiver 1 - Relationship to Student
Parent/Caregiver 1 - Cell Phone
Please enter a valid phone number.Format: 000-000-0000.
Parent/Guardian 1 - Email
example@example.com
Parent/Guardian 1 - Landline or Home Phone
Please enter a valid phone number.Format: 000-000-0000.
Parent/Guardian 1 - Employer
Parent/Caregiver 1 - Occupation
Parent/Caregiver 1 - Work Number
Please enter a valid phone number.Format: 000-000-0000.
Is a translator needed to communicate with Parent/Guardian 1?
What language does Parent/Caregiver 1 speak?
- Parent/Caregiver 2 - Full Name
- Parent/Caregiver 2 - Relationship to Student
- Parent/Caregiver 2 - Cell Phone
  Please enter a valid phone number.Format: 000-000-0000.
- Parent/Caregiver 2 - Email
  example@example.com
- Parent/Caregiver 2 - Landline or Home Phone
  Please enter a valid phone number.Format: 000-000-0000.
- Parent/Caregiver 2 - Employer
- Parent/Caregiver 2 - Occupation
- Parent/Caregiver 2 - Work Number
  Please enter a valid phone number.Format: 000-000-0000.
- Is a translator needed to communicate with Parent/Caregiver 2?
- What language does Parent/Caregiver 2 speak?

Emergency Contacts

Other than Parent/Guardian
- Full Name
- Relationship to Student
- Phone Number
  Please enter a valid phone number.Format: 000-000-0000.
- Is a translator needed to communicate with emergency contact 1?
- What language does emergency contact 1 speak?
- Full Name
- Relationship to Student
- Phone Number
  Please enter a valid phone number.Format: 000-000-0000.
- Is a translator needed to communicate with emergency contact 2?
- What language does emergency contact 2 speak?
- Full Name
- Relationship to Student
- Phone Number
  Please enter a valid phone number.Format: 000-000-0000.
- Is a translator needed to communicate with emergency contact 3?
- What language does emergency contact 3 speak?
- Full Name
- Relationship to Student
- Phone Number
  Please enter a valid phone number.Format: 000-000-0000.
- Is a translator needed to communicate with emergency contact 4?
- What language does emergency contact 4 speak?

Uploads

Please upload all documents you have available this will expedite your registration process.
Custody Paperwork

Cancelof

South Jefferson Elementary
Read the South Jefferson Elementary Family Handbook
I acknowledge that I have read and agree to the South Jefferson Elementary School Student and Family Handbook

Jefferson High School
Read the Jefferson High Family Handbook
I acknowledge that I have read and agree to the Jefferson High School Student and Family Handbook

Submission
By signing below I acknowledge that all submitted information is correct, and I have the right and ability to enroll this student in Jefferson County Schools.
Signature
Type Full Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Locations
Student Information Update 1
example@example.com
Student Information Update 2
example@example.com
School Address
School Phone
School Fax
Should be Empty:

Rows	Yes	No
Heart Defect
Diabetes
Convulsive/Seizure Disorder
Cerebral Palsy
Visual Impairment
a. Corrective Glasses
Hearing Impairment
Hearing Aid
Orthopedic Impairment
Wears Prosthesis
Scoliosis
Behavioral Disorders
Urinary Tract Disorders
Asthma
Allergies
a. Seasonal
b. Food
c. bee sting
Nasal/Respiratory Disorder
Limited Activites
Premature Birth
Other

Student Information Update 2026-2027

Student Contact Information

Siblings in Jefferson County Schools

Household Information

Household 1

Household 2

Emergency Contacts

Notices and Agreements

Student Medical Information

Students Physician Information

Student Medical Information

STUDENT RESIDENCY

Uploads

South Jefferson Elementary

Jefferson High School

Submission