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Document Attachment Form

Please use the form whenever you need to submit any supplemental or support documents to the district. Please be sure to include the student's First and Last Name and Date of Birth. If needed, you can submit more than one of the Document Attachment Forms.

First Name*

Last Name*

Date of Birth*

Proof of Residency: (for those who are residents of Liverpool School District): provide TWO of the following: Mortgage Statement, Signed Lease within last 90 days from current date, Landline Telephone Bill, Cable Bill, Internet Bill, Gas/Electric/Oil Bill, or Water Bill.

Immunization: (English only, signed by a physician)

Custody or guardianship legal documents:

Name of person submitting attachments

Relationship to Student

Date

Other (Report Card, IEP, 504 Plan etc) Specify:

Proof of Student's Age: Please provide one of the following: Birth Certificate (must be certified original), Baptismal Record, Passport

Parent Photo Identification: please provide one of the following: Driver's license or Non-Driver's license, Passport, Sheriff's Identification

Other Health Records and Psychiatric Reports you are willing to share:

Proof of Residency: (IF you are living with a Liverpool Resident): provide ALL of the following:

1) We will need mail with your name on it reflecting the Liverpool address (the mail must be within the same month that you are registering)

2) A utility bill belonging to the person with whom you are residing within the Liverpool School District.

The Residency Affidavit needs to be completed and notarized. You can download a copy of the Affidavit from the Registration page on our website. If you require a Notary, please call the Registration Office at (315) 622-7193 to schedule an appointment.

Please also provide any of the following documents: