Buxton School 2023-2024 Family Information Form

Student Name*

First Middle Last

Preferred Name (if applicable)

Date of Birth*

Student Email Address

Student Cell Number

Grade for 2024-2025*

9
10
11
12

Gender Identity

Male
Female
Nonbinary

If your student uses a term to describe their gender identity other than what is listed above, please share here:*

Pronouns*

Parent/Guardian Living with Student

Parent 1*

Prefix First Middle Last Suffix

Preferred Name (if applicable)

Relationship to Student*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone Number

Cell Phone Number

Work Phone Number

Preferred Number

Home
Cell
Work

Email Address

Occupation/Position

Does your Employer Match Gifts?

Yes
No

If yes: Employer

If yes: Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent 2

Prefix First Middle Last Suffix

Preferred Name (if applicable)

Relationship to Student

Cell Phone Number

Work Phone Number

Preferred Number*

Home
Cell
Work

Email Address

Occupation/Position

Does your Employer Match Gifts?

Yes
No

If yes: Employer

If yes: Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Siblings/ other children (names and birthdays)

Parent/Guardians - second household (if applicable)

Parent 1 Name

Prefix First Middle Last Suffix

Preferred Name (if applicable)

Relationship to Student

Please Send (Mailing Preferences)

All Mail (includes newsletters, invitations, etc)
Only Billing
Only Report Letters
No Mail of any Kind

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone Number

Cell Phone Number

Work Phone Number

Preferred Number

Home
Cell
Work

Email Address

Occupation/Position

Does your Employer Match Gifts?

Yes
No

If yes: Employer

If yes: Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent 2 Name

Prefix First Middle Last Suffix

Preferred Name (if applicable)

Relationship to Student

Cell Phone Number

Work Phone Number

Preferred Number

Home
Cell
Work

Email Address

Occupation/Position

Does your Employer Match Gifts?

Yes
No

If yes: Employer

If yes: Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Siblings/other children (names and birthdays)

Grandparents/Additional Family Members

Grandparents or other family members

We love to include family members in our mailing lists to receive newsletters, invitations, and more! Add their contact information here -- email address & mailing address - and we will add them. Grandparents, aunts, uncles, godparents, whomever you wish to list!

Family Contact List

We also love for Buxton families to be able to connect with one another! In that effort, we compile a family email list to share at the beginning of the year and periodically, to reflect midyear enrollees.

Permission to include you on our family contact list?*

Yes
No

Please list the names and email addresses to add below:

Permission to include your location (hometown/city only) on our family contact list?*

Yes
No

This is mostly to aid in carpooling:)

Comments

This field is for validation purposes and should be left unchanged.

Family Information Form 2024-2025

Parent/Guardian Living with Student

Parent/Guardians - second household (if applicable)

Grandparents/Additional Family Members

Family Contact List