Franklin High School Nurse Emergency Card 2018-2019
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.
Email address *
Your Student's First Name *
please use legal name, no nicknames
Your answer
Student Middle Name *
Use full middle name, no initials; If no middle name, type "NMN"
Your answer
Student Last Name *
Your answer
Student Date of Birth *
Your answer
Your Student's Graduation Year *
The Class of 2023 will be added at the end of the current school year. Parents of incoming 9th graders can complete this form over the summer.
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 *
Your answer
Parent/Guardian#1 Name *
This parent lives with the student; please list full name
Your answer
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.
Your answer
Parent/Guardian#1 best contact Phone Number *
Your answer
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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