SESE Student Registration 2017-2018
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Home Street Address *
Your answer
Student's Home City, State Zip Code *
Example: Anytown, IL 61234
Your answer
Student's Home Phone Number *
Example: 618-123-4567 If you do not have a home phone number, please enter NA.
Your answer
Father's/Guardian's Name *
Please enter first and last name or enter NA if not applicable.
Your answer
Father's/Guardian's Cell Phone Number *
Example: 618-123-4567 If you do not have a cell phone number, please enter NA.
Your answer
Father's/Guardian's Address *
If same as above, check box. If different, please list below with the City, State and Zip Code included or list NA if not applicable.
Father's/Guardian's Email Address *
If you do not have an email address, please enter NA.
Your answer
Father's/Guardian's Employer *
If you do not have an employer, please enter NA.
Your answer
Father's/Guardian's Employer's Phone Number *
Example: 618-123-4567. If you do not have an Employer's phone number, please enter NA.
Your answer
Mother's/Guardian's Name *
Please enter first and last name or enter NA if not applicable
Your answer
Mother's/Guardian's Cell Phone Number *
Example: 618-123-4567 If you do not have a cell phone number, please enter NA.
Your answer
Mother's/Guardian's Address *
If same as above, check box. If different, please list below with the City, State and Zip Code included or enter NA if not applicable.
Mother's/Guardian's Email Address *
If you do not have an email address, please enter NA.
Your answer
Mother's/Guardian's Employer *
If you do not have an employer, please enter NA.
Your answer
Mother's/Guardian's Employer's Phone Number *
Example: 618-123-4567. If you do not have an Employer's phone number, please enter NA.
Your answer
Alternative Person To Contact *
Please enter first and last name.
Your answer
Alternative Person's Phone Number *
Example: 618-123-4567
Your answer
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