Demographic Update

DEMOGRAPHIC UPDATES

Parent's First Name*	Parent's Last Name*	Effective Date*
Student Name(s)*	Grade*	Student Email	Student's Personal Phone (Optional) Listed in Directory



Student(s) resides with:* Mother & Father Mother Father Other	List Other
Father's Information
First Name	Last Name	Email
Mailing Address
City	State	Zip Code
Home Phone	Cell Phone
Business Phone	Alternate Phone
Mother's Information
First Name	Last Name	Email
Mailing Address
City	State	Zip Code
Home Phone	Cell Phone
Business Phone	Alternate Phone
Step Father's Information
First Name	Last Name	Email
Mailing Address:
City	State	Zip Code
Home Phone	Cell Phone
Business Phone	Alternate Phone
Step Mother's Information
First Name	Last Name	Email
Mailing Address
City	State	Zip Code
Home Phone	Cell Phone
Business Phone	Alternate Phone
Billing Address if Different
First Name	Last Name
Billing Address
City	State	Zip Code
Additional Information
Enter the code shown above

* Required