Office of the Superintendent
Pelham Public Schools
18 Franklin Place
Pelham, New York 10803

PLEASE COMPLETE THIS FORM AND CLICK THE "SUBMIT" BUTTON
HELP US PLAN FOR FUTURE STUDENTS


This census information will help us project future enrollment. We need all residents to return this form
as soon as possible.


HELP US GO GREEN AND SAVE TAX DOLLARS


We are collecting household e-mail addresses for community-wide communication. This communication
will be for select and important information only. It will, however, allow a more efficient and cost-effective system of communication with residents. Be sure to white-list pelhamschools.org with your e-mail service or check your spam filter. This list will be for the Pelham Schools' use only.

 

Household Family Name: (Last Name,First Name)

Household Street Address

 

Household Type (Check one):






Neighborhood School District (Check one):





     

Number of Children Living in Your Household (if none, please enter 0):

 

Child's Name:
 
Birth Date (Month/Year):
School Currently or Will Attend:
Child's Name:
Birth Date (Month/Year):
School Currently or Will Attend:
 Child's Name:
Birth Date (Month/Year):
School Currently or Will Attend:
Child's Name:
Birth Date (Month/Year):
School Currently or Will Attend:
Child's Name:
Birth Date (Month/Year):
School Currently or Will Attend:

Preferred Household E-mail for Electronic Community-Wide School District Communication:
(Please make sure you white list pelhamschools.org with your e-mail service or check
your spam filter.)

Do Not Have Access to E-mail
Prefer Postal Mail