Enrollment Packet – Household Information - Three Cords Academy

Household Information for Student:

First

Middle

Last

First Parent / Guardian Full Name

First

Middle

Last

Primary Phone

Primary Email

Occupation

Employer

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Second Birth Gender

Preferred Name

Honorific

Gender

Date of Birth

Relationship to Student

Marital Status

Custodial Rights

Financial Responsibility?

Receive Correspondence?

Highest Level of Education

School Name

Degree

Second Parent / Guardian Information:

Second Parent / Guardian

First

Middle

Last

Primary Phone

Primary Email

Occupation

Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Name

Honorific

Gender

Date of Birth

Relationship to Student

Marital Status

Custodial Rights

Financial Responsibility?

Receive Correspondence?

Highest Level of Education

School Name

Degree

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