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Genesis Parent Portal Request
The completion of this form will grant parent or guardian(s) listed access to the student's Genesis account once it is approved.
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* Required
Student Name
*
Your answer
School Name
*
Your answer
Student Birthdate
*
MM
/
DD
/
YYYY
Student Home Address
*
Your answer
Genesis Parent/Guardian 1 Name
*
Your answer
Genesis Parent/Guardian 1 Current Phone Number
*
Your answer
Genesis Parent/Guardian 1 Email Address
*
Your answer
Genesis Parent/Guardian 2 Name
Your answer
Genesis Parent Guardian 2 Current Phone Number
Your answer
Genesis Parent Guardian 2 Email Address:
Your answer
Does this student have siblings who attend other schools in Orange? If yes, please list each sibling and the school they attend in the area provided below.
*
Yes
No
Sibling Name #1 and the School Name
Your answer
Sibling Name #2 and the School Name
Your answer
Sibling Name #3 and the School Name
Your answer
Sibling Name #4 and the School Name
Your answer
Sibling Name #5 and the School Name
Your answer
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