JCHS Student Data for 2010-2011 - NEW STUDENTS

1. Student Information

Thank you for taking time to complete the JCHS summer data for the academic year 2010-2011. The online forms and release must be completed and submitted before MONDAY, AUGUST 2, 2010. If you have multiple students attending JCHS, please submit separate data for each student.

Please contact Office Manager David Joseph at 415.345.9777 x100 or djoseph@jchsofthebay.org with any questions. Please note that JCHS will be closed for the week of July 4.

Student Information

Student Information Student First Name
Preferred Name (if different from Student First Name)
Middle Name
Last Name
Address
Address 2
City
State
Zip
Home Phone
Student Cell Phone
Student E-mail

Does this student have relatives attending JCHS? If so, please list their names, ages and relation to student.

Parent/Guardian 1 Information

Parent/Guardian 1 Information Parent/Guardian 1 Prefix
Parent/Guardian 1 First Name
Parent/Guardian 1 Middle Name
Parent/Guardian 1 Last Name
Relationship to student
Occupation
Address (if different from student)
Address 2
City
State
Zip
Parent/Guardian 1 Home Phone(if different from student)
Parent/Guardian 1 Cell Phone
Parent/Guardian 1 Work Phone
Parent/Guardian 1 E-mail

Parent/Guardian 2 Information

Parent/Guardian 2 Information Parent/Guardian 2 Prefix
Parent/Guardian 2 First Name
Parent/Guardian 2 Middle Name
Parent/Guardian 2 Last Name
Relationship to student
Occupation
Address (if different from student)
Address 2
City
State
Zip
Parent/Guardian 2 Home Phone
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Work Phone
Parent/Guardian 2 E-mail

Parent/Guardian 3 Information

Parent/Guardian 3 Information Parent/Guardian 3 Prefix
Parent/Guardian 3 First Name
Parent/Guardian 3 Middle Name
Parent/Guardian 3 Last Name
Relationship to student
Occupation
Address (if different from student)
Address 2
City
State
Zip
Parent/Guardian 3 Home Phone(if different from student)
Parent/Guardian 3 Cell Phone
Parent/Guardian 3 Work Phone
Parent/Guardian 3 E-mail

Grandparent Information
JCHS likes to include grandparents in celebrations, fundraising efforts, and communications about events at school. If you would like JCHS to share this information with them, please complete the information below.

Grandparent Information JCHS likes to include grandparents in celebrations, fundraising efforts, and communications about events at school. If you would like JCHS to share this information with them, please complete the information below. (a) Grandparent Full Name (Family 1)
Grandparent Full Name (Family 1)
Address
City
State
Zip
Home Phone
E-mail
(b) Grandparent Full Name (Family 2)
Grandparent Full Name (Family 2)
Address
City
State
Zip
Home Phone
E-mail

If there are any other relatives or significant people in your student's life whom you would like to be included, please complete the information below.

If there are any other relatives or significant people in your student's life whom you would like to be included, please complete the information below. Name
Address
City
State
Zip
Relationship to student
Home Phone
E-mail