Buxton School 2023-2024 Family Information Form

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
Non-Binary/Gender non-conforming

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

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

Siblings/ other children (names and birthdays)

Parent/Guardians - second household (if applicable)

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

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

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!

Sharing Information

Email

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

Family Information Form 2023-2024

Parent/Guardian Living with Student

Parent/Guardians - second household (if applicable)

Grandparents/Additional Family Members

Sharing Information