Parent/Guardian Name

Street Address 1

Street Address 2

City

State

Zip Code

Phone Number

Email

Please tell us the name(s) and date(s) of birth of the child(ren) you wish to enter into the Shaker Heights School System and the grade(s) they will be entering.

Child’s (Children’s) Name(s)		Gender				Date(s) of Birth mm/dd/yyyy		Grade Entering
		Female		Male
		Female		Male
		Female		Male
		Female		Male

If you know your future Shaker Heights address, please enter it here.

Shaker Heights Street Address 1

Shaker Heights Street Address 2