Head of Household Information

First Name

Middle

Last Name

Email Address

Home Phone

Relationship to Student

Emergency Contact?

Financial Responsibility?

						Aunt Father Grandfather Grandmother Guardian Mother Nanny Step-Father Step-Mother Uncle

Other Parent/Guardian Information

If Single Parent/Guardian, Check Here.

First Name

Middle

Last Name

Email Address

Home Phone

Relationship to Student

Emergency Contact?

Financial Responsibility?

						Aunt Father Grandfather Grandmother Guardian Mother Nanny Step-Father Step-Mother Uncle

Student Information

First Name

Middle

Last Name

Email Address (if none, use Parent/Guardian's)