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STUDENT/FAMILY INFORMATION FORM 2011-2012
List all St. James Students below
beginning with the oldest (First, Middle and Last Name)
:
* Student's Name:
Last Name
First Name
Middle Name
Date of Birth
Grade
Race/Ethnicity (optional)
Student's Name:
Last Name
First Name
Middle Name
Date of Birth
Grade
Race/Ethnicity (optional)
Student's Name:
Last Name
First Name
Middle Name
Date of Birth
Grade
Race/Ethnicity (optional)
Student's Name:
Last Name
First Name
Middle Name
Date of Birth
Grade
Race/Ethnicity (optional)
Student's Name:
Last Name
First Name
Middle Name
Date of Birth
Grade
Race/Ethnicity (optional)
* Student's Address:
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Address
City
State
Zip Code
* Parent's Marital Status:
Married
Single
Divorced
Seperated
Widowed
In the boxes below, indicate CP (Custodial Parent) and/or SD (School Directory Information) where applicable:
CP
* Parent 1 Name
* Home Phone
SD
* Home Address
* Email
* Place of Employment
* Work Phone
* Occupation
* Cell Phone
CP
Parent 2 Name
Home Phone
SD
Home Address
Email
Place of Employment
Work Phone
Occupation
Cell Phone
Step-ParentName
Cell Phone
Place of Employment
Business Phone
Grandparent Information - necessary for Grandparent Database and communications
Grandparent 1 Name(s)
Mailing Address
Grandparent(s) Email
Grandparent 2 Name(s)
Mailing Address
Grandparent(s) Email
Church Affiliation (Optional)
Denomination
Congregation
* Would you like The Episcopal Church of the Good Shepherd to send you information about upcoming youth activities?
Yes
No
* = Required Fields
