Warwick School District Census Form

Please review instructions before completing Online Instructions

If you have any questions, please call the district at 717-626-3734, or email us at [email protected].
Warwick School District
301 W. Orange Street
Lititz, PA 17543

If you experience any trouble with the form, please contact us at [email protected]

Note: Options for Completing:
1) No Change - Check box, Fill in Residence #, Street Address and Name at bottom of form
2) Changes - Check box, Fill in Residence #, Street Address, Name at bottom, and areas where changes are needed.
3) New Information - Check box, Fill in Residence #, Street Address, Name at bottom, Fill in complete form.

Enter your Residence ID# from the top left box of the form you received in the mail. Note - Do NOT enter your mailing address here!

Residence #
*If you do not have your Residence #, please contact us.

Residence/Street Address
Street:
Apt #: City:
State: Zip:
THIS SECTION FOR ADULTS 18 AND OVER
Name of Adult
(Last, First, Middle Initial)		 Delete Name
(Put an X to
Delete Name)		 Gender
 		 Birthdate
(00/00/0000)		 Race
 		 Relationship
 
1. Last Name:
First Name: MI:
2. Last Name:
First Name: MI:
3. Last Name:
First Name: MI:
4. Last Name:
First Name: MI:
5. Last Name:
First Name: MI:

THIS SECTION FOR CHILDREN UNDER 18 OR STILL IN HIGH SCHOOL
Name of Child
(Last, First, Middle Initial)		 Delete Name
(Put an X to
Delete Name)		 Gender Birthdate
(00/00/0000)		 Race Name of School
(Current Year)		 Grade
(Current Year)
1. Last Name:
First Name: MI:
2. Last Name:
First Name: MI:
3. Last Name:
First Name: MI:
4. Last Name:
First Name: MI:
5. Last Name:
First Name: MI:
6. Last Name:
First Name: MI:
7. Last Name:
First Name: MI:
8. Last Name:
First Name: MI:
9. Last Name:
First Name: MI:
10. Last Name:
First Name: MI:

If you expect to move prior to July 1, please note date and new address: Date:
Street:
Apt:
City/State/Zip:
ALL INFORMATION IS CONFIDENTIAL
I verify that the information above is complete and accurate:
Full Name:
Date:12/2/2025
Telephone Number:   Check if Unlisted
  Must check a box 1,2 or 3 at top of form before submitting.