2023-2024 student & family update

STUDENT #1 INFORMATION
Student's Full Name*

First NameMiddle NameLast Name
Student Number
This 5 digit # is on their School ID
Class of:*
Student's Non-SRHS Email*
example@gmail.com
Student's Mobile Number*
If your child doesn't have a mobile # then skip
Student's Birth Date*

MonthDayYear
Gender*
Are you an international student*
Municipality*
Municipality of the student's primary household
Ethnicity*
Race*

WhiteBlackAmerican Indian/AlaskanAsianHawaiian native/other Pacific Islander
Military Connected Indicator*

Not Military ConnectedActive Duty - dependent of a member of the Active Duty Forces
Does Student currently have an IEP/ISP or 504 Plan?*
Please upload documents related to IEP/ISP or 504 Plan*

Cancelof

Student #2 Information
Student's Full Name*

First NameMiddle NameLast Name
Student Number*
e.g. 5 Digit Number
Class of:*
Student's Non-SRHS Email*
example@example.com
Student's Mobile Number*
Student's Birth Date*

MonthDayYear
Gender*
Are you an international student*
Municipality*
Municipality of the student's primary household
Ethnicity*
Race*

WhiteBlackAmerican Indian/AlaskanAsianHawaiian native/other Pacific Islander
Military Connected Indicator*

Not Military ConnectedActive Duty - dependent of a member of the Active Duty Forces
Does Student currently have an IEP/ISP or 504 Plan?*
Please upload documents related to IEP/ISP or 504 Plan*

Cancelof

Student #3 Information
Student's Full Name*

First NameMiddle NameLast Name
Student Number*
e.g. 5 Digit Number
Class of:*
Student's Non-SRHS Email*
example@example.com
Student's Mobile Number*
Student's Birth Date*

MonthDayYear
Gender*
Are you an international student*
Municipality*
Municipality of the student's primary household
Ethnicity*
Race*

WhiteBlackAmerican Indian/AlaskanAsianHawaiian native/other Pacific Islander
Military Connected Indicator*

Not Military ConnectedActive Duty - dependent of a member of the Active Duty Forces
Does Student currently have an IEP/ISP or 504 Plan?*
Please upload documents related to IEP/ISP or 504 Plan*

Cancelof

Student #4 Information
Student's Full Name*

First NameMiddle NameLast Name
Student Number*
e.g. 5 Digit Number
Class of:*
Student's Non-SRHS Email*
example@example.com
Student's Mobile Number*
Student's Birth Date*

MonthDayYear
Gender*
Are you an international student*
Municipality*
Municipality of the student's primary household
Ethnicity*
Race*

WhiteBlackAmerican Indian/AlaskanAsianHawaiian native/other Pacific Islander
Military Connected Indicator*

Not Military ConnectedActive Duty - dependent of a member of the Active Duty Forces
Does Student currently have an IEP/ISP or 504 Plan?*
Please upload documents related to IEP/ISP or 504 Plan*

Cancelof

Primary Parent or Guardian in Additional Household
This could be a father who does not live in the primary household but still maintains guardianship/custody
Primary Parent Full Name*

PrefixFirst NameMiddle NameLast NameSuffix
Primary Parent Relationship to Student*
Primary Parent Marital Status*
Primary Parent Home Phone*
Please enter a valid phone number.
Primary Parent Mobile Phone*
Please enter a valid phone number.
Primary Parent Email*
example@example.com
Primary Language Spoken in Household*
Are you an Alum of St. Rose High School?*
Year of Graduation*
Employment Status*

Examples include a Parent/Guardian who lives in the ADDITIONAL Household, for example:
- New Wife of Biological Father who remarried
- New Husband of Biological Mother who remarried
- Grandparent, Aunt, or Uncle living with the child(ren) at the additional household
All individuals listed will have rights to pickup the child(ren) unless documentation is provided specifically stating otherwise.
Is there a second parent or legal guardian in the additional household?*

YesNo

Emergency Contact Information
Typically, an emergency contact is a close family member, a relative, a close friend, or someone who is familiar with your personal circumstances and can act as a point of contact when needed. It's important to choose someone who is reliable, easily reachable, and capable of making important decisions on your behalf if necessary.

St. Rose High School may need to contact these individuals in case of an emergency involving the child when the parents are not available or cannot be reached. Parents should inform the emergency contacts that they have been listed and provide them with any specific instructions or details they need to know.
Contact #1 Full Name*

First NameLast Name
Contact #1 Relationship*
ex. Father, Mother, etc.
Contact #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact #1 Phone*