Student Information Form

Students Name _____________________________________________________

Address ____________________________________________________________
____________________________________________________________________
Home Phone Number __________________________________________________
Hobbies _____________________________________________________________

Parent/Guardian Name _________________________________________________

Address (if different from above) _________________________________________
____________________________________________________________________
Parent/Guardian Phone Number (s) ________________________________________
_____________________________________________________________________
Emergency Contact Information
Emergency Contact person _______________________________________________
Relation to Student _____________________________________________________
Emergency Contact Address ______________________________________________
_____________________________________________________________________
Emergency Contact Phone Number ________________________________________

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