Admission and Information Form

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Date
MM slash DD slash YYYY
Student Name
First Middle Last Suffix
Date of Birth*
MM slash DD slash YYYY
Name child is to be called at school:*
Parent 1 Information
Name*
First Last
Phone*
Business or Secondary Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Do you work outside the home?*
Occupation
Employer
Business Email
Days/Hours Work:
Employer Address
Street Address Address Line 2 City State ZIP Code
Parent 2 Information
Name*
First Last
Phone*
Business or Secondary Phone*
Email*
Address
Street Address Address Line 2 City State ZIP Code
Parent 2 - Do you work outside the home?*
Occupation
Employer
Business Email
Days/Hours Work:
Employer Address
Street Address Address Line 2 City State ZIP Code
Student primarily resides with:
Student's secondary residence:
Other significant adult living in the home:
Relationship
Does your child go to a sitter, another school or daycare center when not at HSPK?*
Name of sitter/facility:
Phone
Days of attendance:
Are there pets in the home? If so, what kind:
Additional Comments
Name
This field is for validation purposes and should be left unchanged.

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Parent 1 Information