Change of Address

***You can now UPDATE CONTACT INFORMATION through your Parent Portal. Please log into your portal to add or make any corrections to your information or anyone on the emergency contact list.

Required Documentation for Change of Address:
Evidence of Residence:
____ Owned residence – deed or property tax assessment records, and a copy of a
current utility (electric/water) bill or initial order for service; and one of the following
current documents supporting stated address: auto registration, Florida driver’s license,
Florida ID card, or voter registration as evidence that parent(s) owns and lives at the
residence.
____ Leased Residence – Current lease or rental agreement or a notarized letter from
the landlord, and a copy of a current utility (electric/water) bill or initial order for
service; and one of the following current documents supporting stated address: auto
registration, driver’s license, Florida ID card, or voter registration as evidence that
parent(s) lives at the residence.

I am requesting to (select all that applies):

I am requesting to (select all that applies): Update my address on file. Update / add my contact number. Update / add my contact email.
I have:

I have: One student currently enrolled at LOLHS. More than one student currently enrolled at LOLHS. (Enter the # of students enrolled)
Student Name: Student Name: First Last
Student Date of Birth: Student Date of Birth: / MM / DD YYYY
Student Number:
Additional Student(s) Enrolled (include date of birth and/or student number):
Additional Student(s) Enrolled (include date of birth and/or student number):
Parent / Guardian Name: Parent / Guardian Name: First Last
Current Address on File Current Address on File
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
New Address New Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
If you are just UPDATING contact info - please upload copy of your ID. If you are also updating the address on file - please upload the THREE required proofs of residency for the new address:

Examples include:
> Owned Residence: deed or property tax assessment records, AND a copy of a current utility (electric/water) bill or initial order for service; AND one of the following current documents supporting new address: auto registration, FL drivers license, FL ID card, or voters registration card as evidence that parent/guardian owns and lives at the residence.

> Leased Residence: Current lease or rental agreement, or a notarized letter from the landlord, AND a copy of a current utility (electric/water/gas/solar) bill or initial order for service; AND one of the following current documents supporting new address: auto registration, FL drivers license, FL ID card, or voters registration card as evidence that parent/guardian owns and lives at the residence.

Attach Files
Does your student need a new bus pass?

Does your student need a new bus pass? Yes No
Phone Contact

Please enter your current contact number. If you need to update your phone number, enter your new number in the spaces provided. To update the emergency pick-up contacts for your student, please visit the LOLHS clinic.
Current Parent / Guardian Phone Number Current Parent / Guardian Phone Number - ### - ### ####
New Cellular Phone Number: New Cellular Phone Number: - ### - ### ####
New Work Number: New Work Number: - ### - ### ####
Other Other - ### - ### ####
Where is the other phone number to:
Email Contact

Please enter your current email address on file. If your email address has not changed, please re-enter your email address in the "New Email Address" section. To change the email address on file, please enter your new email address in the spaces provided.
Current Email Address on File:

Confirm Email Address
New Email Address:

Confirm Email Address
Additional Email Address:
Additional Information:

Please utilize this space to provide additional information (if needed).
Your signature below indicates that all information provided on this document is true and accurate. Then School District expects residence information submitted regarding students to be truthful and accurate, and District forms pertaining to residence and household membership shall be verified under penalties of perjury. Florida Statutes 837.06 provided that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his official duty shall be guilty of a misdemeanor of the second degree. Additional, a person who knowingly makes a false declaration under penalties of perjury commits a felony of the third degree, pursuant to Florida Statute 92.525. Providing school officials false information regarding your residence when enrolling you child may result in your child being withdrawn and/or reassigned to the appropriate zoned school, and referral of the matter to law enforcement for possible criminal prosecution. Additionally, falsification of this information may result in the permanent revocation of your child's privilege to engage in extracurricular activities including organized sports.

Parents / legal guardians are responsible for notifying the school principal or designee if there is a change in residence or parental responsibility of the student within five (5) days, even if the parent thinks the student is still in the school's zone. Failure to give timely notice may result in a reassignment to the student's zoned school and/or loss of eligibility for athletics and other activities.

Please sign below:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Text
Text
Text
Text

Change of Address

Change of Address

Phone Contact

Email Contact

Additional Information: