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  • Student Information Sheet-Address 09-10

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    jfkelley
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    ________________________________ Date of Birth: _________ Date of marriage: _______________ __________________________ Race: Asian Black Hispanic Custody: (circle one) white both parents Am Indian father mother ___________________ Cell Phone: ____________________ Place of employment and Phone: ____________ name of guardian (if not parents): _____________________#_____________________ Emergency name and phone number other than parent / guardian: ___________________ #_____________________ (if

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    3. Student Information Sheet-Address 09-10

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    ________________________________ Date of Birth: _________ Date of marriage: _______________ __________________________ Race: Asian Black Hispanic Custody: (circle one) white both parents Am Indian father mother ___________________ Cell Phone: ____________________ Place of employment and Phone: ____________ name of guardian (if not parents): _____________________#_____________________ Emergency name and phone number other than parent / guardian: ___________________ #_____________________ (if

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    13 views1 page

    Student Information Sheet-Address 09-10

    Uploaded by

    jfkelley
    ________________________________ Date of Birth: _________ Date of marriage: _______________ __________________________ Race: Asian Black Hispanic Custody: (circle one) white both parents Am Indian father mother ___________________ Cell Phone: ____________________ Place of employment and Phone: ____________ name of guardian (if not parents): _____________________#_____________________ Emergency name and phone number other than parent / guardian: ___________________ #_____________________ (if

    Copyright:

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    of 1

    Ronnie Scudder Smith County Middle School Phone

    Principal 134 SCMS Lane 615-735-8277


    Carthage, TN 37030 Fax
    615-735-8255

    Student Name: ______________________________________________ Grade: ______

    Home Phone: __________________________ Bus #: _____ Homeroom: _______

    Address: _______________________________________________________________

    City/State/Zip: ___________________________________________________________

    Social Security Number: __________________________ Date of Birth: ___________

    Race: Asian Black Hispanic White Am Indian Other: ____________

    Custody: (circle one) Both parents Father Mother Other: _______________

    Are there custody concerns involving your child of which we should be aware? Is there

    anyone not allowed to see your child? Yes ____ No ___ (If yes, describe on back)

    Name of father/stepfather: __________________________Cell Phone: _____________

    Place of employment & Phone: ______________________________________________

    Name of mother/stepmother: ________________________ Cell Phone: _____________

    Place of employment & Phone: ______________________________________________

    Name of guardian (if not parents): _______________________ Cell Phone: ____________

    Place of employment & Phone: ______________________________________________

    List names and phone number of those who might be sent by you to check your child out
    of school:

    1. _____________________#_____________ 2._____________________#___________

    3. _____________________#_____________ 4. ____________________#___________
    (You may list additional names on back if necessary)

    Emergency name and phone number other than parent/ guardian:


    _______________________________________________________________________

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