Post by Hauer on Aug 1, 2009 12:32:20 GMT -5
STUDENT INFORMATION
Full Legal Name (Last/Family/Sur Name, First/Given Name, FULL Middle Name) [/size]
Trager, Klause Rodolphus
Preferred Name (If NOT First/Given Name) [/size]
N/A
Former Last Names (If Applicable, Otherwise State ‘Not Applicable’) [/size]
Tulare
Date of Birth and Time (mm/dd/yy, hh:mm AM/PM) [/size]
July 20, 1993, 4:57 AM
Gender (Male/Female) [/size]
Male
Race (Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___ Africa
___Asian
___Latin American
_x_American
___Pacific Islander
___Other (Specify) ______________
Ethnic Background (Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___ Africa
___Asian
___Latin American
_x_American
___Pacific Islander
___Other (Specify) ______________
US Social Security Number (If US Citizen, Otherwise State ‘Not Applicable’) [/size]
729-92-2807
Address (Number and Street, City; State, Zip Code [If Not Applicable, Please indicate Otherwise]) [/size]
2960 Mercator Lane
Winter Park, FL 32789
E-Mail Address ( If Applicable, Otherwise State ‘Not Applicable’; something@somewhere.com) [/size]
klauvebites@gmail.com
IM Address ( If Applicable, Otherwise State ‘Not Applicable’; list all current; username, site) [/size]
N/A
Desired Email and IM Username (Username, Password) [/size]
UN: elitepartyanimal
PW: natisanidiot
Home Phone Number (If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
(407) 809-3927
Cell Phone Number (If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
N/A
HOUSEHOLD INFORMATION
Who Has Legal Custody? ( Place An ‘X’ Beside Any That Apply) [/size]
___Both Parents
___Father
___Mother
___Grandparent(s)
_x_Guardian(s)
___Ward of Court
Student Lives With (Place An ‘X’ Beside Any That Apply) [/size]
___Both Parents
___Father
___Mother
___Step Parent
___Grandparent(s)
___Guardian(s)
___Agency/Social Services
___Foster Parent(s)
___Alone
___Student’s Spouse/Partner
_x_Other Relative(s)
Parent/Guardian’s Legal Name (Last/Family/Sur Name, First/Given Name) [/size]
Trager, Ellen Grace
Name Of Parent(s)/Sibling(s) Whom Attend/Have Attended Rosethorn Institute (Name, Relationship, Current Grade/Year Attended; [Indicate Graduation Date With An Asterisk (*)]
Kenton Tulare, father, 1969-1975*_______
Nathan Tulare, sibling, Grade 11 (attends)
________________________________________
________________________________________
________________________________________
GUARDIAN INFORMATION
Name of Parents/Guardian NOT living in the primary household
(Only list Parents/Guardians that are authorized to have contact with student, but do not live in student’s primary household [Leave Blank If not Applicable]) [/size]
Legal Name: _________________________ Relationship to student: ________________________
Mailing Address: __________________________________________________________________
Place Of Business: ____________________________________________ Hours: ______________
Place Of Business Address: _________________________________________________________
Home Phone: (___)_________ Work Phone: (___)_________ Cell Phone: (___)_________
Legal Name: _________________________ Relationship to student: ________________________
Mailing Address: __________________________________________________________________
Place Of Business: ____________________________________________ Hours: ______________
Place Of Business Address: _________________________________________________________
Home Phone: (___)_________ Work Phone: (___)_________ Cell Phone: (___)_________
Legal Name: _________________________ Relationship to student: ________________________
Mailing Address: __________________________________________________________________
Place Of Business: ____________________________________________ Hours: ______________
Place Of Business Address: _________________________________________________________
Home Phone: (___)_________ Work Phone: (___)_________ Cell Phone: (___)_________
PREVIOUS SCHOOL(S) INFORMATION
Last School Attended
Trinity Preparatory [/color] [/size]
Grade
9th, Freshman
Has your child ever been retained? (Yes or No If yes, what grade?) [/size]
No
Has student attended pre-school? (Yes or No If yes, check one of the following:) [/size]
___PK-Public School
_x_Private Non-Profit PK
___Public Sponsored PK (Title 1)
___Private For Profit PK
___Head Start
___Other Public School
___PK Private School
List other schools student has attended:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Has your child ever received any of the following services? (If yes, check all that apply)
___Special Education* ___Gifted ___Speech* ___ESOL
___EIP Reading/Math ___Remedial ___OT/PT* ___504
No
*If student receives special education including speech or OT/PT, do you have a copy of a current IEP or IAP? [/size] (Yes or No) [/size]
N/A
HOME LANGUAGE SURVEY
Parent or Guardian must complete. [/color]
First Language learned by student?
English
Language student uses at home?
English
Language student uses most often?
English
Country of Origin?
America
Date entered US schools:
August 28, 1997
LEGAL AGREEMENT[/size]
[x] By Checking This Box I Hereby Express My Understanding That Rosethorn Institute For The Genetically Advanced Accepts Full Responsibility For any harm done to students. I hereby surrender this child over to the evil clutches of The Headmaster unknowingly and lots other strange fine print I didn’t even read because I assumed this was just another stupid thing. I did not actually read the small part about my student not being allowed to leave the campus unless permission is granted by The Headmaster himself (even though he would never agree to it) even though I said I read it and agree to it.
Full Legal Name (Last/Family/Sur Name, First/Given Name, FULL Middle Name) [/size]
Trager, Klause Rodolphus
Preferred Name (If NOT First/Given Name) [/size]
N/A
Former Last Names (If Applicable, Otherwise State ‘Not Applicable’) [/size]
Tulare
Date of Birth and Time (mm/dd/yy, hh:mm AM/PM) [/size]
July 20, 1993, 4:57 AM
Gender (Male/Female) [/size]
Male
Race (Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___ Africa
___Asian
___Latin American
_x_American
___Pacific Islander
___Other (Specify) ______________
Ethnic Background (Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___ Africa
___Asian
___Latin American
_x_American
___Pacific Islander
___Other (Specify) ______________
US Social Security Number (If US Citizen, Otherwise State ‘Not Applicable’) [/size]
729-92-2807
Address (Number and Street, City; State, Zip Code [If Not Applicable, Please indicate Otherwise]) [/size]
2960 Mercator Lane
Winter Park, FL 32789
E-Mail Address ( If Applicable, Otherwise State ‘Not Applicable’; something@somewhere.com) [/size]
klauvebites@gmail.com
IM Address ( If Applicable, Otherwise State ‘Not Applicable’; list all current; username, site) [/size]
N/A
Desired Email and IM Username (Username, Password) [/size]
UN: elitepartyanimal
PW: natisanidiot
Home Phone Number (If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
(407) 809-3927
Cell Phone Number (If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
N/A
HOUSEHOLD INFORMATION
Who Has Legal Custody? ( Place An ‘X’ Beside Any That Apply) [/size]
___Both Parents
___Father
___Mother
___Grandparent(s)
_x_Guardian(s)
___Ward of Court
Student Lives With (Place An ‘X’ Beside Any That Apply) [/size]
___Both Parents
___Father
___Mother
___Step Parent
___Grandparent(s)
___Guardian(s)
___Agency/Social Services
___Foster Parent(s)
___Alone
___Student’s Spouse/Partner
_x_Other Relative(s)
Parent/Guardian’s Legal Name (Last/Family/Sur Name, First/Given Name) [/size]
Trager, Ellen Grace
Name Of Parent(s)/Sibling(s) Whom Attend/Have Attended Rosethorn Institute (Name, Relationship, Current Grade/Year Attended; [Indicate Graduation Date With An Asterisk (*)]
Kenton Tulare, father, 1969-1975*_______
Nathan Tulare, sibling, Grade 11 (attends)
________________________________________
________________________________________
________________________________________
GUARDIAN INFORMATION
Name of Parents/Guardian NOT living in the primary household
(Only list Parents/Guardians that are authorized to have contact with student, but do not live in student’s primary household [Leave Blank If not Applicable]) [/size]
Legal Name: _________________________ Relationship to student: ________________________
Mailing Address: __________________________________________________________________
Place Of Business: ____________________________________________ Hours: ______________
Place Of Business Address: _________________________________________________________
Home Phone: (___)_________ Work Phone: (___)_________ Cell Phone: (___)_________
Legal Name: _________________________ Relationship to student: ________________________
Mailing Address: __________________________________________________________________
Place Of Business: ____________________________________________ Hours: ______________
Place Of Business Address: _________________________________________________________
Home Phone: (___)_________ Work Phone: (___)_________ Cell Phone: (___)_________
Legal Name: _________________________ Relationship to student: ________________________
Mailing Address: __________________________________________________________________
Place Of Business: ____________________________________________ Hours: ______________
Place Of Business Address: _________________________________________________________
Home Phone: (___)_________ Work Phone: (___)_________ Cell Phone: (___)_________
PREVIOUS SCHOOL(S) INFORMATION
Last School Attended
Trinity Preparatory [/color] [/size]
Grade
9th, Freshman
Has your child ever been retained? (Yes or No If yes, what grade?) [/size]
No
Has student attended pre-school? (Yes or No If yes, check one of the following:) [/size]
___PK-Public School
_x_Private Non-Profit PK
___Public Sponsored PK (Title 1)
___Private For Profit PK
___Head Start
___Other Public School
___PK Private School
List other schools student has attended:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Has your child ever received any of the following services? (If yes, check all that apply)
___Special Education* ___Gifted ___Speech* ___ESOL
___EIP Reading/Math ___Remedial ___OT/PT* ___504
No
*If student receives special education including speech or OT/PT, do you have a copy of a current IEP or IAP? [/size] (Yes or No) [/size]
N/A
HOME LANGUAGE SURVEY
Parent or Guardian must complete. [/color]
First Language learned by student?
English
Language student uses at home?
English
Language student uses most often?
English
Country of Origin?
America
Date entered US schools:
August 28, 1997
LEGAL AGREEMENT[/size]
[x] By Checking This Box I Hereby Express My Understanding That Rosethorn Institute For The Genetically Advanced Accepts Full Responsibility For any harm done to students. I hereby surrender this child over to the evil clutches of The Headmaster unknowingly and lots other strange fine print I didn’t even read because I assumed this was just another stupid thing. I did not actually read the small part about my student not being allowed to leave the campus unless permission is granted by The Headmaster himself (even though he would never agree to it) even though I said I read it and agree to it.
All Rights Reserved.