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Parent Information Form

Parent Information Form

First Name

Required

Middle Name:

Last Name

Required

Nickname

Suffix:

Maiden Name:

Gender:

Required

Ethnicity:

Religion:

Church Affiliation:

Marital Status:

Required

Spouse First Name:

Son's Name:

Required

What grade is he in?

Required

Does your son live with:

Both Parents
Father
Mother
Other

If your son does not live with you, please list his living address:

Contact Information

Email

Email

Home Phone:

Required

Cell Phone:

Street Address:

Required

City:

Required

State:

Required

Postal Code:

Required

Business Information

Company Name:

Bussiness Title:

Street Address:

City:

State:

Postal Code:

Phone:

Bussiness Email:

Rockhurst High School - 9301 State Line Road - Kansas City, MO 64114-3299 - 816.363.2036
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