Application For Determination Of Residency Conroe Independent School District Page 2
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1
2Application for Determination of Residency
Conroe Independent School District
To be completed by parent or guardian
This document is evidence of the fact that I hereby assign
,
(name of temporary custodian)
__________________________________________________________________________________________
a resident of the Conroe Independent School District, temporary custodial powers of my son/daughter,
, minor,
years of age.
(name of student)
_______________________________________________________________________________________________________________________________________________
_________________
will live with the above named
(Name of student)
_______________________________________________________________________________________________________________________________________________
person at
,
(address of temporary custodian)
__________________________________________________________________________________________________________________________________________________________________
and I understand that school district personnel will communicate only with the custodian for all school-related matters, including, but not
limited to, the discipline, medical treatment, grade reporting, financial obligations, and attendance of my child.
__________________________________________________________________________________________
Signature of parent/legal guardian
State of Texas
County of Montgomery
SWORN TO AND SUBSCRIBED before me, by
_____________________________________________________________________________________________________________________________________
On the
day of
, 20
.
___________________________________
__________________________________________________________________
_____________________
__________________________________________________________________________________________
Notary Public in and for the State of Texas
To be completed by parent or guardian
I
, hereby accept temporary custodial powers of,
(name of temporary custodian)
__________________________________________________________________________________________
. I understand that I am
(name of student)
________________________________________________________________________________________________________________________________________________________
responsible for all school-related matters, including, but not limited to, the discipline, medical treatment, grade reporting, financial
obligations, and attendance involving
(name of student)
_______________________________________________________________________________________________________________________________________
__________________________________________________________________________________________
Signature of temporary custodian
State of Texas
County of Montgomery
SWORN TO AND SUBSCRIBED before me, by
_____________________________________________________________________________________________________________________________________
On the
day of
, 20
.
___________________________________
__________________________________________________________________
_____________________
__________________________________________________________________________________________
Notary Public in and for the State of Texas
Approved
Date
by
____________________________________________________
________________________________________________________
___________________________________________________________
Approved
Date
by
____________________________________________________
________________________________________________________
___________________________________________________________
CISD-58 (7/03)
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