Rocky Hill Public Schools Change of Student Contact Information Form 2018-19 School Year
Central Registration Office Information:
Mr. Thomas Kennison, M.S.A., M.B.A.
Registration/Residency Officer
761 Old Main Street, Suite 231 (Town Hall)
Rocky Hill, CT 06067
Phone: (860) 258-7701 Ext. 1177
Fax: (860) 258-7710
Email: kennisont@rockyhillps.com
Instructions:
Please fill-out this online Change of Student Contact Information Form if you need to change phone numbers, email addresses, emergency contacts or automated alert information. This form in not for changing addresses. Please see the Change of Address Form [COA] website at www.rockyhillps.com, click on Central Registration and then Student Change of Address [COA].
Questions, please call Mr. Kennison at (860) 258-7701 Ext 1177. Please note - One form for each student is required.
Student Information:
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Gender *
School (Please select one) *
Grade *
Required
Student's Best Contact Number (XXX-XXX-XXXX) *
Your answer
Resides With *
Mother's Information:
Natural or Adoptive Mother Only
Mother's First Name
Your answer
Mother's Last Name
Your answer
Mother's Address (if different)
Your answer
Mother's Home Phone (XXX-XXX-XXXX)
Your answer
Mother's Day Phone (XXX-XXX-XXXX)
Your answer
Mother's Cell Phone (XXX-XXX-XXXX)
Your answer
Mother's Email Address
Your answer
Father's Information:
Natural or Adoptive Father Only
Father's First Name
Your answer
Father's Last Name
Your answer
Father's Address (if different)
Your answer
Father's Home Phone (XXX-XXX-XXXX)
Your answer
Father's Day Phone (XXX-XXX-XXXX)
Your answer
Father's Cell Phone (XXX-XXX-XXXX)
Your answer
Father's Email Address
Your answer
Guardian's Information (Other than natural parent):
Includes step-father or step-mother, domestic partners, grandparents, etc.
Guardian 1: First Name
Your answer
Guardian 1: Last Name
Your answer
Guardian 1: Home Phone
Your answer
Guardian 1: Day Phone (XXX-XXX-XXXX)
Your answer
Guardian 1: Cell Phone (XXX-XXX-XXXX)
Your answer
Guardian 1: Email
Your answer
Guardian 2: First Name
Your answer
Guardian 2: Last Name
Your answer
Guardian 2: Home Phone (XXX-XXX-XXXX)
Your answer
Guardian 2: Day Phone (XXX-XXX-XXXX)
Your answer
Guardian 2: Cell Phone (XXX-XXX-XXXX)
Your answer
Guardian 2: Email Address
Your answer
Emergency Contact Information
Other than parents/legal guardians. School will always call parents first. If no emergency contact persons are available, please leave blank.
Emergency Contact 1: Full Name
Your answer
Emergency Contact 2: Best Contact Number (XXX-XXX-XXXX)
Your answer
Emergency Contact 2: Full Name
Your answer
Emergency Contact 2: Best Contact Number (XXX-XXX-XXXX)
Your answer
Emergency Contact 3: Full Name
Your answer
Emergency Contact 3: Best Contact Number (XXX-XXX-XXXX)
Your answer
Automated Alert Messages (all announcements):
School cancellations, delays, early releases, school events, etc.
Phone 1 (xxx-xxx-xxxx)
Your answer
Text 1 (xxx-xxx-xxxx)
Your answer
Email 1
Your answer
Phone 2 (xxx-xxx-xxxx)
Your answer
Text 2 (xxx-xxx-xxxx)
Your answer
Email 2
Your answer
Electronic Signature of Parent or Legal Guardian *
Your answer
Date: *
MM
/
DD
/
YYYY
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