Sample Student Information Form Page 2
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2Family Information
Church Affiliation___________________________________________________________________________
Name of Father__________________________________________________/___________________________
place of birth
Name of Mother_________________________________________________/___________________________
place of birth
Name of Guardian___________________________________________________________________________
Last name
First name
Home phone number_______________________________Emergency phone___________________________
Number of children in family___________________ # older_____________ # younger ___________________
Education of Father______________(years)_________________(years)
high school
college
Education of Mother______________(years)_________________(years)
high school
college
Occupation of Father_________________________________________________________________________
Father’s work phone number_______________________________________________
Occupation of Mother________________________________________________________________________
Mother’s work phone number______________________________________________
Grandparent Information:
Name(s)___________________________________________ Phone__________________________________
Address____________________________________________________________________________________
street or box number
city
state
zip
Name(s)___________________________________________ Phone__________________________________
Address____________________________________________________________________________________
street or box number
city
state
zip
Note: Before entering kindergarten/first grade, Immunization Records must be up to date. All parents must
show that their child has been immunized against D.P.T, measles, and polio before the first day of school.
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