Parent Information Form
Student First Name *
Your answer
Student Last Name *
Your answer
Parent 1 First Name *
Your answer
Parent 1 Last Name *
Your answer
Parent 1 Home Address (if different than Student)
Your answer
Parent 1 Cell Phone Number (XXX) XXX-XXXX *
Your answer
Text Messages? *
Does parent receive text messages as part of their cell phone plan?
Parent 1 Email Address *
Your answer
Parent 1 Place of Employment *
Your answer
Parent 2 First Name
Your answer
Parent 2 Last Name
Your answer
Parent 2 Home Address (if different than Student)
Your answer
Parent 2 Cell Phone Number (XXX) XXX-XXXX
Your answer
Text Messages?
Does dad receive text messages as part of his cell phone plan?
Parent 2 Email Address
Your answer
Parent 2 Place of Employment
Your answer
Named Emergency Contact * *
Name of person other than a parent that we can contact in case of an emergency
Your answer
Emergency Contact Relationship *
Emergency Contact Phone *
Please use this format: xxx-xxx-xxxx
Your answer
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