Family Registration Form
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4F
R
F
AMILY
EGISTRATION
ORM
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SHEET
OF
Parent/Guardian Information
Registration Date:
School Directory: Would you like your family to be included in our school directory? [ ] Yes [ ] No
Parent /Guardian 1 First Name:
M.I.
Last Name:
Address:
Date of Birth:
Home Phone: (
)
Cell Phone:
(
)
Cell Carrier/Provider:
Work Phone: (
)
Occupation/Employer:
Work Address:
[ ] Custodial Parent (If married, mark both parents)
Social Security #:
Email:
Driver’s License #:
Marital Status: [ ] Married [ ] Single [ ] Divorced [ ] Separated [ ] Widowed [ ] Other____________________
Relationship to Child: [ ] Mother [ ] Father [ ] Grandparent [ ] Foster Parent
[ ] Other____________________
Mark All that Apply: [ ] Child Lives With [ ] Emergency Contact [ ] Authorized Pickup
Is there is other information you would like us to know?
Parent /Guardian 2 First Name:
M.I.
Last Name:
Address:
Date of Birth:
Home Phone: (
)
Cell Phone:
(
)
Cell Carrier/Provider:
Work Phone: (
)
Occupation/Employer:
Work Address:
[ ] Custodial Parent (If married, mark both parents)
Social Security #:
Email:
Driver’s License #:
Marital Status: [ ] Married [ ] Single [ ] Divorced [ ] Separated [ ] Widowed [ ] Other____________________
Relationship to Child: [ ] Mother [ ] Father [ ] Grandparent [ ] Foster Parent
[ ] Other____________________
Mark All that Apply: [ ] Child Lives With [ ] Emergency Contact [ ] Authorized Pickup
Is there is other information you would like us to know?
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Parent category: Life