Student Information Form
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1
2
3STUDENT INFORMATION --- FRONT OFFICE
S
: _____________________________ ________________________________ ________
TUDENT
First Name
Last Name
5-digit ID
H
T
_____________________ G
: ___ B
: ______________
M
F
OMEROOM
EACHER
RADE
IRTHDATE
ALE
EMALE
H
A
: _________________________________________________________
ZIP _________________
OME
DDRESS
S
D
: _______________________________________
H
P
: _____________________
UB
IVISION
OME
HONE
DIRECTIONS TO HOME: _________________________________________________________________________
Regular Transportation:
Bus Route #
Car Rider
Other
S
R
: ______________________________
EMAIL: _________________________________
TUDENT
ESIDES WITH
If different than physical address
(
)
M
A
: _______________________________________________________
ZIP _________________
AILING
DDRESS
P
A
S
P
C
(Use name on Driver’s License)
ERSONS
UTHORIZED TO PICK UP
TUDENT AND
HONE
ONTACT INFORMATION
Parent/Guardian: ______________________________________________________
Relationship: ______________
Primary Contact Phone #: ________________________ Alternate Contact Phone #: ___________________________
Parent/Guardian: ______________________________________________________
Relationship: ______________
Primary Contact Phone #: ________________________ Alternate Contact Phone #: ___________________________
Other/Name: ___________________________________ Phone: _______________
Relationship: ______________
Other/Name: ___________________________________ Phone: _______________
Relationship: ______________
Other/Name: ___________________________________ Phone: _______________
Relationship: ______________
S
P
(We are concerned with the safety of your child, please check appropriate box)
TUDENT
ROTECTION
There is not a problem at the present time with mother and/or father picking child up at school.
There is a problem with (name) ______________________________ picking child up at school.*
(*Note: If checked, custody/legal court documents must be on file in the school office.)
List all brothers and sisters living in the household:
Name: ____________________________
Age: _______
Name: _______________________________ Age ___ Name: ____________________________
Age: _______
Name: _______________________________ Age ___ Name: ____________________________
Age: _______
Your primary residence must be within the legal boundaries of Montgomery Independent School District. A
person who knowingly falsifies information on a form required for a student's enrollment in the District shall be
liable to the district if the student is not eligible for enrollment, but is enrolled, on the basis of false information.
This liability is equal to the amount the District has budgeted for each student for the current year for
maintenance and operating expenses for the current school year.
I understand the above enrollment information and agree with the terms.
Date: _________________________________
Parent Signature:
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