Student Information Form
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SCSC Student Information 2021-22 School Year
As part of the enrollment process, SCSC must collect contact information and data pertaining to your student. Please complete this survey for your student.
As part of the enrollment process, SCSC must collect contact information and data pertaining to your student. Please complete this survey for your student.
1.
Student Name
*
First
Last
Student
2.
Grade in 2021-2022
*
--Please Select--
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
3.
Student Address
*
Street Address:
City:
State:
Zip:
4.
Parent 1 Contact Info
*
Enter N/A for any phone type(s) that do not apply.
Relationship:
Name:
Street Address:
City:
State:
Zip:
Home phone:
Cell phone:
Work phone:
Email:
5.
Parent 2 Contact Info
Enter N/A for any phone type(s) that do not apply.
Relationship:
Name:
Street Address:
City:
State:
Zip:
Home phone:
Cell phone:
Work phone:
E-mail
6.
Emergency Contact 1 (Contact may not be a parent)
*
Enter N/A for any phone type(s) that do not apply.
Name:
Relationship:
Street Address:
City:
State:
Zip:
Cell Phone:
Home Phone:
Work Phone:
7.
Emergency Contact 2 (Contact may not be a parent.)
*
Enter N/A for any phone type(s) that do not apply.
Name:
Relationship:
Street Address:
City:
State:
Zip:
Cell Phone:
Home Phone:
Work Phone:
8.
Parent Completion
*
By entering my name below, I indicate that I am authorized to make decisions regarding my child.
Name
Date
Name and Date