3rd Grade Student Information Sheet - Holy Rosary School (Page 2 of 2) in pdf

3rd Grade Student Information Sheet - Holy Rosary School Page 2

5th

GRADE STUDENT INFORMATION SHEET

2014/2015

STUDENT’S NAME___________________________________________

HOME ADDRESS_____________________________________________

_____________________________________________

HOME TELEPHONE NUMBER_________________________________

STUDENT’S DATE OF BIRTH__________________________________

STUDENT’S HEIGHT IN INCHES____________________*needed for

STUDENT’S WEIGHT ___________________________medical records

MOTHER’S NAME___________________________________________

WORK NUMBER_____________________________________________

CELL PHONE NUMBER_______________________________________

E-MAIL ADDRESS___________________________________________

FATHER’S NAME____________________________________________

WORK NUMBER_____________________________________________

CELL PHONE NUMBER_______________________________________

ANY KNOWN ALLERGIES OR MEDICAL CONDITIONS THE SCHOOL SHOULD

BE AWARE OF:

_____________________________________________________________________________

_____________________________________________

DOES YOUR CHILD WEAR EYEGLASSES?_________IF SO FOR WHAT REASON?

Example: reading, blackboard, always.

_____________________________________________________________

*PLEASE NOTE: Should any of this information change during the school year please

notify the teacher. It is important that all information be current should you have to be

reached during any emergency situation. Thank you for your cooperation.

3rd Grade Student Information Sheet - Holy Rosary School Page 2