South Central High School Information Sheet - South Central Schools
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1South Central High School is going GREEN!
Do you have a computer or computer access?
_____ Yes
_____ No
If answer is yes, please provided PARENT(S) email address:
___________________________________________
SOUTH CENTRAL HIGH SCHOOL
INFORMATION SHEET
Name:________________________________________________________________________________________________
(First)
(Complete Middle Name)
(Last)
Address:______________________________ P.O. Box (if any):_________
Township:_________________
City:__________________________________ Zip:_____________ Grade Level: _______________
Student's BIRTH City:_____________________
County: __________________
State:_____________
Social Security #:_____________________
Birthdate:_______________ Sex: Male:_____ Female:_____
Home Phone:____________________________
Absence Phone (if different): ______________________________
Student’s Cell Phone (if any): ___________________
Please provide numbers to be put in School Reach below.
Please limit to 3 PARENT numbers only.
_____________________________________________________
Does student live more than 1 1/2 miles from school? YES _____ NO_____
Please list at least 2 emergency contacts:
Child will only be released to those names listed. Please list both names (Tom & Sue) if either can pick up.
Daytime
1. Emergency Person (other than yourself) _____________________________________Phone:__________________________
Daytime
2. Emergency Person (other than yourself)______________________________________Phone:__________________________
Please circle one
Other (g’parent?)_________________________________
Child lives with: Both Mother Father
Legal Joint
Custody
Father's name:____________________________________
Mother's name:___________________________________
Address:________________________________________
Address:________________________________________
(if different from child)
(if different from child)
City:_________________________ Zip:_______________
City:__________________________Zip:______________
Home phone (if different):___________________________
Home phone (if different):__________________________
Cell #, if any______________________________________
Cell #, if any_____________________________________
Employer:____________________Phone:______________
Employer:____________________Phone:______________
Birth Mother’s Maiden Name:______________________
(Required to assign State ID number)
If applicable (separation/divorce), to whom should additional copies of student’s information be mailed?
Name: _______________________________
Address: _____________________________
City: ________________ Zip: ____________
________________________________________________
Signature of Parent/Guardian
Date
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