Northshore School District Enrollment Form Page 2
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4PARENT/GUARDIAN INFORMATION (
.)
List the parents/guardians the student lives with first, then by contact order
❑
❑
❑
❑
Restrictions for Custody (if applicable)
Yes
No
Legal Documentation on File with School?
Yes
No
First Parent / Guardian
Mr./Mrs./Ms./_____ Last Name ____________________________________
First Name ______________________________________________
❑
❑
❑
❑
Relationship to Student ________________________________________
Lives with Student?
Yes
No
Has Custody?
Yes
No
Address (if different from Student’s) __________________________________________________________________________________________
❑
❑
List as an Emergency Contact?
Yes
No
Primary Language ________________________________
Email Address ____________________________
Employer _______________________
Bus. Phone. (____)
❑
❑
❑
❑
Primary Contact Phone #(____) _______________________
Home
Cell
Unlisted?
Yes
No
❑
❑
❑
❑
2nd Contact Phone #(____) __________________________
Home
Cell
Unlisted?
Yes
No
❑
❑
❑
❑
Educational Rights:
Yes
No
.Student Contact Allowed?
Yes
No
Second Parent / Guardian
Mr./Mrs./Ms./_____ Last Name ____________________________________
First Name ______________________________________________
❑
❑
❑
❑
Relationship to Student ____________________________________
Lives with Student?
Yes
No
Has Custody?
Yes
No
Address (if different from Student’s) __________________________________________________________________________________________
❑
❑
List as an Emergency Contact?
Yes
No
Primary Language ________________________________
Email Address ____________________________
Employer
Bus. Phone. (____) __________________________
❑
❑
❑
❑
Primary Contact Phone #(____)
Home
Cell
Unlisted?
Yes
No
❑
❑
❑
❑
2nd Contact Phone #(____) __________________________
Home
Cell
Unlisted?
Yes
No
❑
❑
❑
❑
❑
❑
Receive Mailings?
Yes
No
Educational Rights:
Yes
No
Student Contact Allowed?
Yes
No
Third Parent / Guardian
Mr./Mrs./Ms./_____ Last Name ____________________________________
First Name ______________________________________________
❑
❑
❑
❑
Relationship to Student ____________________________________
Lives with Student?
Yes
No
Has Custody?
Yes
No
Address (if different from Student’s) __________________________________________________________________________________________
❑
❑
List as an Emergency Contact?
Yes
No
Primary Language ________________________________
Email Address ____________________________
Employer
Bus. Phone. (____) __________________________
❑
❑
❑
❑
Primary Contact Phone #(____) _______________________
Home
Cell
Unlisted?
Yes
No
❑
❑
❑
❑
2nd Contact Phone #(____) __________________________
Home
Cell
Unlisted?
Yes
No
❑
❑
❑
❑
❑
❑
Receive Mailings?
Yes
No
Educational Rights:
Yes
No
Student Contact Allowed?
Yes
No
Fourth Parent / Guardian
Mr./Mrs./Ms./_____ Last Name ____________________________________
First Name ______________________________________________
❑
❑
❑
❑
Relationship to Student ____________________________________
Lives with Student?
Yes
No
Has Custody?
Yes
No
Address (if different from Student’s) __________________________________________________________________________________________
List as an Emergency Contact? ❑ Yes ❑ No
Primary Language ________________________________
Email Address ____________________________
Employer _______________________
Bus. Phone. (____)
❑
❑
❑
❑
Primary Contact Phone #(____) _______________________
Home
Cell
Unlisted?
Yes
No
❑
❑
❑
❑
2nd Contact Phone #(____) __________________________
Home
Cell
Unlisted?
Yes
No
❑
❑
❑
❑
❑
❑
Receive Mailings?
Yes
No
Educational Rights:
Yes
No
Student Contact Allowed?
Yes
No
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