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Personal Data Sheet 2013/2014 Family Last Name: ______________________ Home Phone: ______________________ Address: ________________________________________________________________ Street

City

State

Zip code

Mother’s Name: ______________________ Email Address: _______________________ Cell Phone: __________________________ Work Phone: ________________________ Occupation: ____________________________ Religion: _________________________ Father’s Name: ______________________ Email Address: ________________________ Cell Phone: _________________________ Work Phone: _________________________ Occupation: ____________________________ Religion: _________________________

Student Last Name

Student First Name

Birth Date

Social Security number

Grade 2013/ 2014

Baptized Y/N

Catholic Y/N

Ethnic Code

Ethnic Codes: 1=American Indian/Alaskan Native; 2=Asian, Asian-American or Pacific Islander; 3=Black or African-American; 4=Caucasian; 5=Latin, South or Central American; 6=Mexican-American or Chicano; 7=Puerto Rican; 8= Other Hispanic

Student(s) live(s) with (Check all that apply): ____ Both parents in one household ____ Mother ____ Father ____ Grandparent ____ Other (please explain):________________________ If more than one please explain: _______________________________________________ Is there a custodial agreement that pertains to the student(s)? (Yes or No) __________ All custodial agreements must be on file with the front office. It is the responsibility of the parents to provide all court and legal documents in regards to the custody of students.

Student(s) may be released to the following adults (please include parents) Last Name

First Name

Relationship

Phone Number

Drivers License #


OSCS Personal data sheet 2013 2014