Student Information Sheet - Moscow School District printable pdf download

Moscow High School

Date ___________________

Student Information Card

Grade: 9 10 11 12

Please circle correct choice

To be filled out as completely as possible by Parent/Guardian-----Please Print

Student’s Legal Name

___________________________________/________________________________/___________________

Last

First

Middle

Gender: Male Female

______/_______/__________

________________________

Birth Date mm/dd/yyyy

Please circle one

Student’s Cell Phone #

Student’s Email

Student Lives With:

Father/Mother

Mother Only

Father Only

Blended Family

Father & Step-Mother

Mother & Step-Father

Guardian

Other

(

Circle one)

Family Information:

Father’s Name _________________________________________________ Employer ____________________________

Mailing Address__________________________________________City______________________Zip_______________

Home Phone__________________________ Work Phone ______________________ Cell Phone___________________

Home Email _________________________________________ Work Email ____________________________________

Mother’s Name ________________________________________________ Employer ____________________________

Mailing Address__________________________________________City_____________________Zip________________

Home Phone__________________________ Work Phone ______________________ Cell Phone___________________

Home Email __________________________________________ Work Email ___________________________________

Step Parent/Guardian’s Name ______________________________________ Employer ___________________________

Mailing Address__________________________________________City______________________Zip_______________

Home Phone__________________________ Work Phone ______________________ Cell Phone___________________

Home Email __________________________________________ Work Email ___________________________________

*By giving your Email address to the school, you are providing consent to transfer confidential information in an electronic format. The Moscow School District makes

every effort to protect their Email system, but please be aware there is some security risk.

Local Emergency Contact other than above: ______________________________________________________________

Address ______________________________________________________________ Relationship___________________

Home Phone________________________ Work Phone _____________________ Cell Phone______________________

Local Emergency Contact other than above: ______________________________________________________________

Address _______________________________________________________________ Relationship__________________

Home Phone________________________ Work Phone _____________________ Cell Phone______________________

Any special medical problems? (Continue on back if necessary) _______________________________________________

☐ Parent/Guardian and Student have reviewed School Policies including the Violence Policy

in the Student Handbook.

(Please check box and sign below)

Parent/Guardian Signature ___________________________

Student Signature_______________________________

School will release student and/or student information only to the persons listed on this card unless notified by the parent.

Student Information Sheet - Moscow School District

Related Articles

Related forms

Related Categories