| Name (last, first MI) |
,
|
| Lineage (Suffix) |
|
Nickname |
| Home Phone |
|
| Home Street |
Map |
| Home city, state, zip |
,
|
| Residency |
Expiration date of lease if Renting
|
| Mailing Street |
Map |
| Mailing city, state, zip |
,
|
| Gender |
|
Student Number (PS#) |
|
| Home Room |
|
SSN |
|
| Birth date (mm/dd/yyyy) |
|
Directory Listing Permission |
|
| Graduation Year |
|
Photo/Video Permission |
|
| Reporting Ethnicity
|
Internet Use Permission |
|
|
|
PARENT/GUARDIAN  
|
| Lives With |
|
| Mother's Name |
(Needs to be formatted like: Doe, John) |
| Mother's Day Phone |
Cell Phone
|
| Mother's Home Phone |
|
| Mother's Email |
|
| Mother's Employer |
|
| Mother's Maiden Name |
(LAST NAME ONLY) |
| Father's Name |
(Needs to be formatted like: Doe, John) |
| Father's Day Phone |
Cell Phone
|
| Father's Home Phone |
|
| Father's Email |
|
| Father's Employer |
|
| Guardianship |
Single Parent Household
|
| Guardian(Last, First, Middle) |
|
| Guardian's Day Phone |
Cell Phone
|
| Guardian Email |
(Separate multiple emails with commas, do not include any spaces) |
| Guardian Alert Text |
|
|
EMERGENCY/MEDICAL INFO
|
| Emergency Contact #1 |
|
| Contact #1 Phone |
|
| Contact #1 Relationship |
|
Phone Type
|
| Emergency Contact #2 |
|
| Contact #2 Phone |
|
| Contact #2 Relationship |
|
Phone Type
|
| Emergency Contact #3 |
|
| Contact #3 Phone |
|
| Contact #3 Relationship |
|
Phone Type
|
| Doctor |
|
Doctor Phone#
|
| Dentist |
|
Dentist Phone#
|
| Medical Alert Text |
|
|
|