Buxton School 2022-2023 Family Information Form

Family Information Form 2022-2023

Required form (one per family). Due 8/1/22.

Student Name*
First Middle Last
Preferred Name (nickname)
Date of Birth*
Student Email Address
Student Cell Number
Grade for 2022-2023*
- 9
- 10
- 11
- 12
Gender*
- Male
- Female
- Self Identity
Gender Pronouns*
Parent/Guardian Living with Student
Parent 1*
Prefix First Middle Last Suffix
Preferred Name (nickname)
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
School(s) Attended
Parent 2
Prefix First Middle Last Suffix
Preferred Name (nickname)
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
School(s) Attended
Other Children
Please list the names and relationships of other children. Please specify if the child is a step and/or half sibling.
Parent/Guardians NOT Living with Student
Parent 1 Name
Prefix First Middle Last Suffix
Preferred Name (nickname)
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
School(s) Attended
Parent 2 Name
Prefix First Middle Last Suffix
Preferred Name (nickname)
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
School(s) Attended
Other Children
Please list the names and relationships of other children. Please specify if the child is a step and/or half sibling.
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!
Sharing Information
Permission to include your information (address, phone number) on our student roster which is distributed to students and families?*
- Yes
- No
Email
This field is for validation purposes and should be left unchanged.

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Family Information Form 2022-2023

Parent/Guardian Living with Student

Parent/Guardians NOT Living with Student

Grandparents/Additional Family Members

Sharing Information