Precious Blood School

STUDENT LAST NAME *

STUDENT FIRST NAME *

STUDENT'S DATE OF BIRTH *

Home Address (complete address with Street, Blvd or Ave. with unit number if appllicable) *

PARENT/GUARDIAN'S FIRST AND LAST NAME *

PARENT/GUARDIAN'S CELL PHONE NUMBER *

PARENT/GUARDIAN'S EMAIL ADDRESS *

LAUSD

CATHOLIC HIGH SCHOOL

OTHER SCHOOLS

IF RECORDS ARE TO BE SENT TO ANOTHER SCHOOL,PLEASE PUT NAME AND COMPLETE MAILING ADDRESS OF SCHOOL

PRINTED NAME OF PARENT/GUARDIAN *

Date TODAY *

Single line *

AUTHORIZATION TO RELEASE RECORDS