Antelope Union High School            Entry Date:_____________

                                                                            Student Registration

                Name (Nombre):_______________________________________ Date (Fecha)____________   Grade:______

                Last School Attended (Utiam escuela asistido):__________________________________________

                City (Ciudad):_______________________________  ST_____________________

                DOB (Fecha de nacimiento):____________________________ Placce of birth (city):_________________ State:_________

                Sex: Male/ Female       Ethnic Background: White,  Hispanic/ Latino, African America, Asain/ Pacific islander, Other

                Social Security number:  __ __ __--__ __--__ __ __ __

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            Name of Father (or whom you live with):______________________________________________________________

            Place of Father's (or whom you live with)  Employment:__________________________________________________

            Name of Mother( or whom you live with): ______________________________________________________________

            Place of Mother's (or whom you live with): ______________________________________________________________

            Mailing Address (with whom you live): _________________________________________________________________

          Physical Address: ________________________________________________________________________________

           Telephone #