Student Information - GSCC
This form should be completed by parent/student each year.
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Email *
Student First Name *
Student Middle Name
Student Last Name *
Grade Level *
Sex *
Birthdate *
MM
/
DD
/
YYYY
Race *
Student Cell Phone # *
Home High School *
How do you ARRIVE to Golden Strip each day? *
How do you DEPART from Golden Strip each day? *
GSCC Course *
Do you attend GSCC in the AM or PM? *
Whom do you live with? *
Relationship to person you live with: *
Mailing Address: *
City *
Zip Code *
Parent/Guardian 1 Name *
Parent/Guardian 1 Daytime Phone Number (cell or work) *
Parent Guardian 2 Name
Parent/Guardian 2 Daytime Phone Number (cell or work)
Parent/guardian Email Address *
Emergency Contact Name *
Emergency Contact Phone Number *
List any serious allergies or medical problems *
List any prescription medications you take daily *
Name 1 - List the NAME & PHONE NUMBER of parent, guardian, family member, or friend who you authorize to pick up your child for early dismissal (Identification is required) *
Name 2 - List the NAME & PHONE NUMBER of parent, guardian, family member, or friend who you authorize to pick up your child for early dismissal (Identification is required) *
Name 3 - List the NAME & PHONE NUMBER of parent, guardian, family member, or friend who you authorize to pick up your child for early dismissal (Identification is required) *
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