INFORMATION UPDATE FORM
Please use this form to update the Kenston Intermediate School office
with any changes to a student’s information. Print or write legibly.
Please return in an envelope addressed to the KIS office.
Complete all of this first section.
STUDENT’S FULL NAME ________________________________
HOMEROOM TEACHER ___________________ ROOM # _____
complete only the items which need to be updated
For the following,
on the student’s records or have changed since the beginning of the school year.
STREET ADDRESS
_________________________________
(STUDENT’S)
POST OFFICE & ZIP CODE ___________________________________
HOME PHONE # ________________
PARENT FULL NAME(S) ________________________________
PARENT ADDRESS ____________________________________
MOM
DAD
(
or
)
POST OFFICE & ZIP CODE ______________________________
please circle
PARENT HOME PHONE # __________________ Mom
PARENT WORK PHONE # __________________ Mom
PARENT CELL PHONE # ___________________ Mom
PARENT HOME PHONE # __________________ Dad
PARENT WORK PHONE # __________________ Dad
PARENT CELL PHONE # ___________________ Dad
EMERGENCY CONTACTS (ADD):
FULL NAME _______________________ Relationship _________
STREET ADDRESS _____________________________________
POST OFFICE & ZIP CODE _______________________________
HOME PHONE # _____________ WORK PHONE # ____________
CELL PHONE # ______________
EMERGENCY CONTACTS (DELETE):
FULL NAME _______________________ Relationship __________
OTHER INFORMATION (divorce, guardianship, other):
_____________________________________________________
_____________________________________________________
For changes to medical information or conditions, please contact the
school nurse or health aide as soon as possible.
PARENT SIGNATURE __________________ DATE _______