Franklin High School Nurse Emergency Card 2017-2018
Please submit this information yearly for each of your FHS Students so the FHS School Nurse will have your most current contact information, alternate emergency contacts, and a list of your student's health issues. If this form cannot accommodate the amount of information you need to disclose to the school nurse, Ms. Conroy, please call her at (508)-613-1472. Once you click "submit" you will receive a confirmation that we received your submission of this form.
Your Student's First Name
please use legal name, no nicknames
Student Middle Name
Use full middle name, no initials; If no middle name, type "NMN"
Student Last Name
Student Date of Birth
Your Student's Graduation Year
The Class of 2022 will be added at the end of the current school year. Parents of incoming 9th graders can complete this form over the summer.
Class of 2022
Class of 2021
Class of 2020
Class of 2019
Student Address that they share with Parent/Guardian#1
If this address is different from the one we have on file for you and your student in Aspen, you are required to go to the Franklin School Superintendent's Office (3rd Floor- Franklin Municipal Building) and obtain a Residency Statement and mail or bring it to the FHS Main Office.The Superintendent will change your address in Aspen at that time.
Student's Street Address
This parent lives with the student; please list full name
Parent/Guardian #1 relationship to student
Parent/Guardian#1 Email address
if no email address type "NONE"; This may be the same as the one you listed above.
Parent/Guardian#1 best contact Phone Number
Is this Parent/Guardian#1's home, mobile, or work phone?
Does Parent/Guardian #1 have any other phone numbers they wish to share?
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