RAMAPO CENTRAL SCHOOL DISTRICT NEW REGISTRANT HOUSEHOLD FORM Student Name Home Phone # ____________________________

Surname of the Household_____________________ Contact Priority__________

Address__________________________ City__________ State________ Zip________ Mailing Address, if different________________________________________________________________ (If Hillburn or Tallman fill in Post Office Box Number) Dominant Home Language______________________ Proof of Guardianship__________________________ Resident Type: Lease Own Rent Trailer Park/Condo Unit Unknown Proof of Residency: Mortgage statement Property Tax Bill Real Estate Statement Lease Secondary Proof: Utility Bill PARENTS/GUARDIANS WITH WHOM CHILD RESIDES: Name ____________________________________________________________ (Last) (First) (Middle) Relationship______________________ Phone 1__________________________________Phone Type Cell Home Office Contact Priority__ Phone 2__________________________________Phone Type Cell Home Office Contact Priority Email address______________________ Employer’s Name __________________ Employer’s Phone # __________________Priority_________ Employer’s Address ______________________________________________ (City) (State/Zip) Name ____________________________________________________________ (Last) (First) (Middle) Relationship_________________________ Phone 1__________________________________Phone Type Cell Home Office Contact Priority Phone 2__________________________________Phone Type Cell Home Office Contact Priority Email address_____________________________________ Employer’s Name ____________________ Employer’s Phone # _________________Priority__________ Employer’s Address _____________________________________________ (City) ( State/Zip) Other Children who reside in household Name ____________________________________ DOB________

Gender

Male

Female

Name ____________________________________ DOB________

Gender

Male

Female

Name ____________________________________ DOB________

Gender

Male

Female

Name ____________________________________ DOB________

Gender

Male

Female

Only to be filled out if Parent/Guardian lives outside the household Name ___________________________________________________________ (Last) (First) (Middle) Relationship____________________________________ Address______________________________________________________Correspondence Yes No (City) ( State/Zip) Phone1__________________________________Phone Type Cell Home Office Contact Priority Phone2__________________________________Phone Type

Cell

Home

Office Contact Priority