Warwick School District Census Form

Note - This Online Census Form is No Longer Available as of 6/1/19. Please use the paper mail form for all responses. Thank you.

Please review instructions before completing
Online Instructions

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

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

(All CAPS)
(Include DASH as shown)

Residence #

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:	12/13/2019
Telephone Number:	Check if Unlisted
	Must check a box 1,2 or 3 at top of form before submitting.

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

If you experience any trouble with the form, please contact us at info@dhfassociates.com