Student Registration Form Page 3
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4PARENT AND/OR LEGAL GUARDIAN INFORMATION ONLY
No
Not Applicable
If No Access, legal documentation required. Documentation Received: Yes
Contact priority should be based on whom to call in the case of an emergency and/or school closure.
Note: If e-mail address is provided, the school may use it for contact purposes.
1) Last Name _________________________________________________ First Name _______________________________
Male
Female
Self-Identify as ____________
(Please check all applicable boxes.)
Legal documents (custody order) are required to change this information
Relationship
Access to Student
Guardian
Lives with Student
Mother
Access to Records
Custody
Speaks School Language
Father
No Access
Receives Mail
Step Parent
Parent
(Circle below, 1 = high, 4 = low)
Foster Parent
Legal Guardian
For Emergency: Priority 1 2 3 4
For School Closure: Priority 1 2 3 4
Home No. _ _ _ - _ _ _ - _ _ _ _
Cell. No. _ _ _ - _ _ _ - _ _ _ _
E-mail Address __________________________
Place of Employment _________________________________________
Business No. _ _ _ - _ _ _ - _ _ _ _ ext. _ _ _ _
Home Mailing Address (complete only if different from student)
No. ______
Street ___________________________ Apt. No. _____
Unit No. ______
Suite No. _____
R.R. # ___ P.O. Box ________ Gen. Del. # _______ City/Town ____________ Prov. _____ Postal Code_______
2) Last Name _________________________________________________ First Name _______________________________
Male
Female Self-Identify as ____________
(Please check all applicable boxes.)
Legal documents (custody order) are required to change this information.
Relationship
Access to Student
Guardian
Lives with Student
Mother
Access to Records
Custody
Speaks School Language
Father
No Access
Receives Mail
Step Parent
Parent
(Circle below, 1 = high, 4 = low)
Foster Parent
Legal Guardian
For Emergency: Priority 1 2 3 4
For School Closure: Priority 1 2 3 4
Home No._ _ _ - _ _ _ - _ _ _ _
Cell. No._ _ _ - _ _ _ - _ _ _ _
E-mail Address __________________________
Place of Employment _________________________________________
Business No. _ _ _ - _ _ _ - _ _ _ _ ext. _ _ _ _
Home Mailing Address (complete only if different from student)
No. ______
Street ___________________________ Apt. No. _____
Unit No. ______
Suite No. _____
R.R. # ___ P.O. Box ________ Gen. Del. # _______ City/Town ____________ Prov. _____ Postal Code_______
3) Last Name _________________________________________________ First Name _______________________________
Male
Female Self-Identify as ____________
(Please check all applicable boxes.)
Legal documents (custody order) are required to change this information
Relationship
Access to Student
Guardian
Lives with Student
Mother
Access to Records
Custody
Speaks School Language
Father
No Access
Receives Mail
Step Parent
Parent
(Circle below, 1 = high, 4 = low)
Foster Parent
Legal Guardian
For Emergency: Priority 1 2 3 4
For School Closure: Priority 1 2 3 4
Home No. _ _ _ - _ _ _ - _ _ _ _
Cell. No. _ _ _ - _ _ _ - _ _ _ _
E-mail Address __________________________
Place of Employment _________________________________________
Business No. _ _ _ - _ _ _ - _ _ _ _ ext. _ _ _ _
Home Mailing Address (complete only if different from student)
No. ______
Street ___________________________ Apt. No. _____
Unit No. ______
Suite No. _____
R.R. # ___ P.O. Box ________ Gen. Del. # _______ City/Town ____________ Prov. _____ Postal Code_______
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