Student Data Sheet
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dStudent Personal Data Miramar High School Last Name: _______________________________________ First Name and Middle Initial: ___________________________________ Student Number: ___________________
Grade: ___________________
Birthday: _____________________ Preferred Name Used in Class: _____________________ After school activites:____________________________________________________________ Do you have computer & internet access at home? _____________________ Home Address: __________________________________ City: _____________________________ Zip: _________ Cell Phone: _____________________________ Can you receive text msgs? _______________ Student Email: ______________________________ Mother or Primary Guardian Name: ______________________________ Occupation: ______________________________________________ Home Phone: __________________________________ Business Phone: ________________________________ Cell Phone: ______________________________________ Email: _____________________________________________ Father or Secondary Guardian Name: ______________________________ Occupation: ______________________________________________ Home Phone: __________________________________ Business Phone: ________________________________ Cell Phone: ______________________________________ Email: _____________________________________________
Student Signature
Date
Parent/Guardian Signature
Date
Grade: ___________________
Birthday: _____________________ Preferred Name Used in Class: _____________________ After school activites:____________________________________________________________ Do you have computer & internet access at home? _____________________ Home Address: __________________________________ City: _____________________________ Zip: _________ Cell Phone: _____________________________ Can you receive text msgs? _______________ Student Email: ______________________________ Mother or Primary Guardian Name: ______________________________ Occupation: ______________________________________________ Home Phone: __________________________________ Business Phone: ________________________________ Cell Phone: ______________________________________ Email: _____________________________________________ Father or Secondary Guardian Name: ______________________________ Occupation: ______________________________________________ Home Phone: __________________________________ Business Phone: ________________________________ Cell Phone: ______________________________________ Email: _____________________________________________
Student Signature
Date
Parent/Guardian Signature
Date
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