If you have changed student's address or listed people who may not contact the student, please upload

the
necessary documentation or schedule an appointment with the student's school to complete the process.
Follow the instructions below.

Proof of residency - As per the 2018-19 Enrollment Requirements At the beginning of each school year
and with each residence change, the school shall obtain from the parent/guardian at least one (1) of the items
described below to demonstrate residence at the address given. The documentation should be kept as a part
of the student record. All addresses of MPS students and their legal parent/guardian(s) will be checked and
verified through various third party agencies.

Primary Proof of Residence

1. Utility Bills or Deposit Receipts for electric or gas service only a. Must be current- within 30 days – for
electric or gas service

2. Apartment or Home Lease/ Mortgage a. Apartment/ Home lease- Official document – only to be used if all
utilities are included b. Monthly Mortgage statement- must be current- within 30 days

Secondary Proofs:

1. Property Tax Records or Deeds- Tax Receipt, Property Deed- (Please blacken out any personal financial
information)

2. Income Tax Records- Copy of check from the IRS, Correspondence from the IRS

3. Social Security Checks or other correspondence from Social Security Office

4. Correspondence from other U.S. Government agencies- (Dept. of Human Resources, Food Stamp Office)

5. Employment Records- Paycheck stub issued from employer showing physical address of employee within
the last 30 days

Proof of court order or social restriction - If there is someone not allowed to contact the student, please
upload a copy of the court order or custody agreement or deliver it to the student(s) school.

Should you have any questions or need any additional information please contact your student(s) school. A
listing of Montgomery Public Schools can be found here http://www.mps.k12.al.us/for_parents/how_to_enroll
/2018-2019_enrollment_information_and_form
 STUDENT UPDATE FORM
Montgomery Public Schools
Student's Name: CARTAVIOUS JAKEEM MOORE
School: CARVER ELEMENTARY SCHOOL:0110
Grade: 04
Today's Date: 07/01/2019

Student Information
Name: CARTAVIOUS JAKEEM MOORE
Student ID: S933023 Date of Birth: 01/27/2010
Grade: 04 Gender: Male:1
Academic Session: 618

Custody Agreement in Place: No

Please contact the school nurse if there has been a change in the student's medical information. I
acknowledge

Guardian Information
Guardian 1 Information

Name: PEGGY JOHNSON

Gender: Female:2
Address:
City, State, Zip code:
Updated Address: ,
Updated City, State, Zip code:
Primary Phone: (334)240-2221 Alternate Phone: (334)398-4673
Email: pjwilliams3326@gmail.com
Employer: Work Phone: 3342205001

Guardian 2 Information

Name:
Updated Name:
Gender:
Is the second guardian's mailing address the same as the first guardian's mailing address?
Address:
City, State, Zip code:
Updated Address: ,
,
Updated City, State, Zip code:
Primary Phone: Alternate Phone:
Email: Work Phone:
Employer:

Social Restrictions
Is there any individual who is not permitted to contact the student? No
Name: Reason:
Restraining order: Restricting pick up:
Domestic violence DHR custody and/or involvement:
Penelope house:

Would you like to list an additional individual?

Name: Reason:
Restraining order: Restricting pick up:
Domestic violence DHR custody and/or involvement:
Penelope house:

Red Flag Code:

Emergency Contact(s)
Emergency Contact 1
Name:
Relationship to Student: Gender:
Primary Phone: Alternate Phone:
Updated Name: Peggy Dotson
Updated Relationship to Student: Aunt:1 Updated Gender: Female:2
Updated Primary Phone: (334)730-3311 Updated Alternate Phone:
Allowed to pick up student: Yes

Emergency Contact 2
Name:
Relationship to Student: Gender:
Primary Phone: Alternate Phone:
Updated Name: Mattaniah Dotson
Updated Relationship to Student: Aunt:1 Updated Gender: Female:2
Updated Primary Phone: (334)833-5805 Updated Alternate Phone:
Allowed to pick up student: Yes

Emergency Contact 3
Name:
Relationship to Student: Gender:
Primary Phone: Alternate Phone:
Updated Name: Clarence Dotson
Updated Relationship to Student: Grandfather:5 Updated Gender: Male:1
Updated Primary Phone: (334)314-4751 Updated Alternate Phone: (334)603-4760
Allowed to pick up student: Yes

Emergency Contact 4
Name:
Relationship to Student: Gender:
Primary Phone: Alternate Phone:
Updated Name: Darryl Norris
Updated Relationship to Student: Uncle:12 Updated Gender: Male:1
Updated Primary Phone: (334)543-6849 Updated Alternate Phone:
Allowed to pick up student: Yes

Emergency Contact 5
Name:
Relationship to Student: Gender:
Primary Phone: Alternate Phone:
Updated Name:
Updated Relationship to Student: Updated Gender:
Updated Primary Phone: Updated Alternate Phone:
Allowed to pick up student:

I have completed this student: Yes

Parent/Guardian's Electronic Signature: Peggy A. Johnson Today's Date: 07/01/2019
Application Number: 1520764 Stamp at Completion: 2019-07-01 13:56:03
 Digital Media Release Form
Montgomery Public Schools
Student's name: CARTAVIOUS JAKEEM MOORE
Gender: Male:1
School: CARVER ELEMENTARY SCHOOL:0110
Grade: 04
Today's Date: 07/01/2019

I hereby give Montgomery Public Schools the right and permission to publish, use photographs or
video, and or audio recordings of my child, a student enrolled in Montgomery Public Schools. I
understand that such reproductions could be used to publicize or promote the school system, and/or
my child's school through its own media productions (district website, social media, printed and/or
online brochures, reports, promotional videos, etc.) or through the commercial media (television,
radio, Internet or print). I waive the right to inspect and/or approve the finished product and do
release Montgomery Public Schools from any liability by virtue of distortion by processing. I further
agree that these items may be used for publication, broadcast or reproduction without limitation or
reservation or any fee.

I/We hereby acknowledge by our initials that we have received, read and understand, and/or had read
to us and understand, the Media Release Form.

Parent/Guardian 1 Initials:

Please type your name. It is your legally binding signature: