Thank you for pre-registering your student.
As a first step, please fill out this form accurately. This will start the process of enrolling your student.

When you have finished this Pre-Registration form, please call Mr. Michael Jones 570-522-3202 to make an appointment to present the required documents (Immunizations, Birth Certificate, and Proof of Residency).

If you are pre-registering for next year's Kindergarten class, you will need to bring these documents to your Kindergarten Registration appointment at Kelly Elementary (you will get a letter with appointment information).


Student Information
Legal Name from Birth Certificate
**Legal Name: **First: Middle: **Last:
**Date of Birth:
**Gender:
Preferred First Name:
**School:
**Previous School:
Enter NONE in all three boxes
if Kindergarten student
School Name:
City:
State:
**Grade Level: If you are registering for this school year, enter your student's current grade level. If you are registering for next fall, enter next year's grade level.
**Anticipated Start Date:
Current Special Programs IEP 504 ELL Speech Therapy
**Prior LASD Enrollment Were you ever enrolled in the Lewisburg Area School District?
**School Year Please select which school year you are registering for.
Parent/Guardian Information
**First Name: **Last Name:
**Relationship to Student:
Other Students in Family: Check this box if other members of your family are active students at our schools
**Desired User Name: Desired User Name for PowerSchool Login
**Email:
**Phone: 999-999-9999      Alternate Phone: 999-999-9999
**Street:
**City:
**State:
**Zip Code:
**Verification: I verify that the above information is correct
** Required Information