Holy Family Catholic School Student Information Form
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Email *
Student Name *
Date of Birth *
MM
/
DD
/
YYYY
Grade Level *
Primary Phone Number *
Secondary Phone Number
Public School District of Residency *
Religion *
Mother's Name
Mother's Phone Number
Mother's Email
Father's Name
Father's Phone Number
Father's Email
Adults approved to sign student out of school* (please include contact phone number):

*Any adult NOT included on this list will be prohibited from signing student out of school.
 *
Emergency Contacts (including phone numbers): *
Child's Physician (including phone number): *
In case of accident or serious illness, I request the school contact me. If the school is unable to reach me, I hereby authorize the school to call the physician indicated above, and to follow his/her directions. If it is impossible to contact this physician, the school may make whatever arrangements are necessary.
*
Required
Electronic Signature *
Names of Persons Prohibited from Picking Up You Child: *
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