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Student Information Sheet
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* Indicates required question
Email
*
Your email
Student's Last Name
*
Your answer
Student's Middle Name
*
Your answer
Student's First Name
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Sex
*
Male
Female
Phone Number for receiving Connect Ed Messages
*
Your answer
Property Address (Street # and Name)
*
Your answer
Town/City
*
Your answer
Zip Code
*
Your answer
Mailing Address (Street # and Name or PO Box)
Your answer
Town/City
Your answer
Zip Code
Your answer
Mother/Guardian Name
*
Your answer
Email Address
*
Your answer
Address (if different from above)
Your answer
Home Number/Cell Number
*
Your answer
Employer Name
*
Your answer
Employer Phone Number
*
Your answer
Custody of Student?
*
Yes
No
Living With
*
Yes
No
Allowed to pick up from school?
*
Yes
No
Father/Guardian Name
*
Your answer
Email Address
*
Your answer
Address (if different from above)
Your answer
Home Number/Cell Number
*
Your answer
Employer Name
*
Your answer
Employer Phone Number
*
Your answer
Custody
*
Yes
No
Living With
*
Yes
No
Allowed to pick up from school?
*
Yes
No
Step Mother/Guardian Name
Your answer
Address (if different from above)
Your answer
Home Number/Cell Number
Your answer
Email Address
Your answer
Employer Name
Your answer
Employer Phone Number
Your answer
Custody
Yes
No
Clear selection
Living With
Yes
No
Clear selection
Allowed to pick up from school?
Yes
No
Clear selection
Step Father/Guardian
Your answer
Address (if different from above)
Your answer
Home/Cell Number
Your answer
Email Address
Your answer
Employer Name
Your answer
Employer Phone Number
Your answer
Custody
Yes
No
Clear selection
Living With
Yes
No
Clear selection
Allowed to pick up from school?
Yes
No
Clear selection
(1) Emergency Contact (when parents cannot be reached)
*
Your answer
Emergency Contact Phone Number
*
Your answer
(2) Emergency Contact (when parents cannot be reached)
*
Your answer
Emergency Contact Phone Number
*
Your answer
Name of Sibling in Moore County Schools
Your answer
Name of Sibling School
Your answer
Name of Sibling in Moore County Schools
Your answer
Name of Sibling School
Your answer
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