Rochester School District Student Information Rochester Middle School 2020-2021
Please fill out this form for EACH child that you have attending the Rochester Middle School.
(The person completing this form is considered Parent/Guardian #1 and this e-mail address will be considered their primary e-mail)
Email *
Student's First Name *
Student's Last Name *
Student's Gender *
Student's Date of Birth *
Student's Current Grade (for the 2020-2021 School Year) *
Student's Primary Street Address *
Where he/she spends most nights.
Student's Primary Town *
Mailing Address (if different from above)
Full name of Parent/Guardian #1
Relationship of Parent/Legal Guardian #1
Clear selection
Parent/Guardian #1 Primary phone number
Please indicate the best number to use to reach you during the school day.
Parent/Guardian #1 alternate phone number
Include this number if you may not be available at the number above.
Full name of Parent/Guardian #2
Relationship of Parent/Legal Guardian #2
Clear selection
Parent/Guardian Primary #2 phone number
Please indicate the best number to use to reach you during the school day.
Parent/Guardian #2 alternate phone number
Include this number if you may not be available at the number above.
Parent/ Guardian #2 e-mail address
Please indicate the best e-mail to receive teacher and school communication.
With Whom Does this Student Reside? *
Has either the student or a parent/guardian changed their address in the past year? *
This helps the school update records from year-to-year.
If the answer to the previous question was "yes," please indicate which address(es) is/are new.
This helps the school update records year-to-year.
Has either parent/guardian changed a phone number in the past year? *
This helps the school update records year-to-year
If the answer to the previous question was "yes," please indicate which phone number(s) are new.
Are there any special custody provisions? *
If these provisions have recently changed, please call the Rochester Middle School at 603-332-4090.
If parent/guardian lives in a different household, please list secondary household guardian name and address. Write NA if not applicable. *
If these provisions have recently changed, please contact the Rochester Middle School at 603-332-4090.
Is either parent/guardian active military? *
The State of NH is asking to provide military data as part of their annual enrollment reports.
If the answer to the previous question was "yes," please indicate which parent/guardian and if active duty in Armed Forces or Full Time National Guard.
Photo Opt-Out
Your son/daughter has the right to request that their photo NOT to be released through video or printed in any publication. If you would like to exercise that right please check the box
Report Cards
Paper printouts of report cards have been discontinued and all information including grades can be accessed by parents/students through Infinite Campus portal. To sign-up for access to the IC portal please call 603-332-4090. If you wish to receive a paper copy please let up know by checking the box.
Emergency/Dismissal Contact #1 *
Please list readily available people you would like for us to have on file who will assume temporary care of child if you cannot be reached.
Emergency Contact's #1 relationship to the student *
Emergency Contact #1 Primary Phone Number *
Emergency Contact #1 Alternate Phone Number
Emergency/Dismissal Contact #2 *
Please list readily available people you would like for us to have on file who will assume temporary care of child if you cannot be reached.
Emergency Contact #2 relationship to the student *
Emergency Contact #2 Primary Phone Number *
Emergency Contact #2 Alternate Phone Number
Name of Student's Physician *
Physician's office phone number
Please list any health conditions/treatments
Including allergies (be specific), medications, chronic health conditions (asthma, seizures, etc), glasses/vision concerns, hearing concerns, significant injuries, etc. This information may be shared with those people who work with your child. If you have other confidential information you do not wish to list here but may affect your child's health care, please contact your child's school nurse.
By printing your name in the box below, you acknowledge that you are the above student's parent/ legal guardian and that the information provided on this form is correct. *
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